MEDICARE: CARRIE L MICHAELS M.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	IMF42424	CA

General Provider Information

NPI Number	:	1356353593
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARRIE L MICHAELS M.A.

Provider Business Mailing Address
First Line	:	2330 GLENDALE LN STE 100
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95825-2454
Country	:	US
Telephone Number	:	916-641-9595
Fax Number	:	916-641-9599

Provider Business Practice Location Address
First Line	:	2330 GLENDALE LN
Second Line	:	STE 100
City	:	SACRAMENTO
State	:	CA
Zip	:	95825-2454
Country	:	US
Telephone Number	:	916-641-9595
Fax Number	:	916-641-9599

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/13/2006
Last Update Date	:	07/08/2007

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