Healthcare Provider Details

I. General information

NPI: 1376818716
Provider Name (Legal Business Name): MICHAEL MCGRATH MA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/19/2012
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 S KING ST
JACKSON WY
83001-8124
US

IV. Provider business mailing address

PO BOX 771
JACKSON WY
83001-0771
US

V. Phone/Fax

Practice location:
  • Phone: 307-699-2956
  • Fax:
Mailing address:
  • Phone: 307-699-2956
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC 35565
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: