=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154775278
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MICHAEL KESSLER LPCC, CRC, RMT
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/14/2016
-----------------------------------------------------
Last Update Date | 04/14/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3060 EL CERRITO PLZ 253
-----------------------------------------------------
City | EL CERRITO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94530-4011
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 415-710-7728
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3060 EL CERRITO PLZ 253
-----------------------------------------------------
City | EL CERRITO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94530-4011
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 415-710-7728
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | LPCC637
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------