Healthcare Provider Details

I. General information

NPI: 1447567896
Provider Name (Legal Business Name): MICHAEL ALLEN MARUYAMA AMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/07/2010
Last Update Date: 10/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1168 SENTINEL CT
MERCED CA
95340-0677
US

IV. Provider business mailing address

1168 SENTINEL CT
MERCED CA
95340-0677
US

V. Phone/Fax

Practice location:
  • Phone: 209-725-0719
  • Fax:
Mailing address:
  • Phone: 209-725-0719
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberAMFT110748
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: