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General NPI Number Information
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NPI Number | 1760535330
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Entity Type | Individual
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Provider Name | MICHAEL FREDRIC THADEN LM.F.T., A.T.R., CHT
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Gender | Male
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Dates
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Enumeration Date | 01/18/2007
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Last Update Date | 05/14/2013
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Provider Practice Location Address
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Address Line | 3550 WATT AVE SUITE 190
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City | SACRAMENTO
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State | CA
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Zip | 95821-2667
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Country | US
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Telephone | 916-505-5092
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 164
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City | ORANGEVALE
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State | CA
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Zip | 95662-0164
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Country | US
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Telephone | 916-505-5092
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | MFC34167
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License Number State | CA
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