Basic Information
| Provider Information | |||||||||
| NPI: | 1922202118 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SPIELMAN | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | DAVID | ||||||||
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| Credential: | MFT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2380 PROFESSIONAL DR | ||||||||
| Address2: | |||||||||
| City: | SANTA ROSA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 954033016 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7075712233 | ||||||||
| FaxNumber: | 7075712238 | ||||||||
| Practice Location | |||||||||
| Address1: | 440 ARROWOOD DR | ||||||||
| Address2: | |||||||||
| City: | SANTA ROSA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 954077503 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7072842950 | ||||||||
| FaxNumber: | 7072842955 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/12/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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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 | 19174 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.