Healthcare Provider Details

I. General information

NPI: 1093653792
Provider Name (Legal Business Name): MICELI THERAPY & WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2026
Last Update Date: 03/23/2026
Certification Date: 03/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2103 GULLANE WAY
GILROY CA
95020-3085
US

IV. Provider business mailing address

2103 GULLANE WAY
GILROY CA
95020-3085
US

V. Phone/Fax

Practice location:
  • Phone: 408-612-7316
  • Fax:
Mailing address:
  • Phone: 408-612-7316
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: MR. MICHAEL JAMES MICELI
Title or Position: OWNER
Credential: LMFT
Phone: 408-612-7316