Healthcare Provider Details

I. General information

NPI: 1225488331
Provider Name (Legal Business Name): MICAELA BIRT M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2016
Last Update Date: 08/07/2023
Certification Date: 08/07/2023
Deactivation Date: 01/19/2018
Reactivation Date: 09/06/2018

III. Provider practice location address

1 QUALITY DR
VACAVILLE CA
95688-9494
US

IV. Provider business mailing address

1 QUALITY DR DEPT OF
VACAVILLE CA
95688-9494
US

V. Phone/Fax

Practice location:
  • Phone: 530-219-1621
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: