Healthcare Provider Details

I. General information

NPI: 1184868820
Provider Name (Legal Business Name): MICHAEL PATRICK LYSAGHT LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2009
Last Update Date: 03/27/2023
Certification Date: 03/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1919 21ST ST STE 207
SACRAMENTO CA
95811-6827
US

IV. Provider business mailing address

1919 21ST ST STE 207
SACRAMENTO CA
95811-6827
US

V. Phone/Fax

Practice location:
  • Phone: 415-205-2788
  • Fax: 408-384-5070
Mailing address:
  • Phone: 415-205-2788
  • Fax: 408-384-5070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC77671
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: