MEDICARE: MARY ROY MICHAELS MFT

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	101YM0800X	Mental Health Counselor	MFC20302	CA

General Provider Information

NPI Number	:	1861529026
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY ROY MICHAELS MFT

Provider Business Mailing Address
First Line	:	57 SADDLE RD.
Second Line	:
City	:	WALNUT CREEK
State	:	CA
Zip	:	94595
Country	:	US
Telephone Number	:	925-932-5072
Fax Number	:	925-933-8871

Provider Business Practice Location Address
First Line	:	3184 OLD TUNNEL RD
Second Line	:
City	:	LAFAYETTE
State	:	CA
Zip	:	94549-4153
Country	:	US
Telephone Number	:	925-932-5072
Fax Number	:	925-933-8871

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

Provider Enumeration Date	:	02/27/2007
Last Update Date	:	07/08/2007

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