Basic Information
| Provider Information | |||||||||
| NPI: | 1356878748 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FELICIANO | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | LUIS | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MFTI, PCCI | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | FELICIANO | ||||||||
| OtherFirstName: | MICHAEL | ||||||||
| OtherMiddleName: | LUIS | ||||||||
| OtherNamePrefix: | MR. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | MFTI, PCCI | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 3637 MISSION AVE BLDG B | ||||||||
| Address2: | |||||||||
| City: | CARMICHAEL | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956082946 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9164854175 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 9719 LINCOLN VILLAGE DR STE 300 | ||||||||
| Address2: | |||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958273330 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9164854175 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/16/2017 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | IMF80927 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.