Healthcare Provider Details

I. General information

NPI: 1790985042
Provider Name (Legal Business Name): MR. MICHAEL CHARLES CHRISTIAN KESSLER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: MR. MICKI ANN WILLIAMS

II. Dates (important events)

Enumeration Date: 07/24/2007
Last Update Date: 05/11/2021
Certification Date: 05/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

490 MENDOCINO AVE SUITE 202
SANTA ROSA CA
95401-8530
US

IV. Provider business mailing address

2227 CAPRICORN WAY STE 207
SANTA ROSA CA
95407-5486
US

V. Phone/Fax

Practice location:
  • Phone: 707-494-2974
  • Fax: 415-565-4881
Mailing address:
  • Phone: 707-565-5006
  • Fax: 707-565-4907

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberASW24005
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberASW 62549
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberASW 62549
License Number StateCA
# 5
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW73368
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: