Healthcare Provider Details

I. General information

NPI: 1437434024
Provider Name (Legal Business Name): KAREN I. MICHAELS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2011
Last Update Date: 10/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5905 SOQUEL DR STE. 550
SOQUEL CA
95073-2861
US

IV. Provider business mailing address

530 VISTA DEL MAR DR
APTOS CA
95003-4816
US

V. Phone/Fax

Practice location:
  • Phone: 831-234-0314
  • Fax: 831-685-0350
Mailing address:
  • Phone: 831-234-0314
  • Fax: 831-685-0350

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License Number23546
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number23546
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number23546
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number23546
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number23546
License Number StateCA
# 6
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number23546
License Number StateCA
# 7
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number23546
License Number StateCA

VIII. Authorized Official

Name: DR. KAREN INGRID MICHAELS
Title or Position: LICENSED CLINICAL PSYCHOLOGIST
Credential: PHD
Phone: 831-234-0314