Provider Demographics
NPI:1043605686
Name:MICHAELS, KATY (MSW)
Entity Type:Individual
Prefix:
First Name:KATY
Middle Name:
Last Name:MICHAELS
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:ETHAN
Other - Middle Name:BRIAN
Other - Last Name:MICHAELS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:39000 BOB HOPE DR
Mailing Address - Street 2:
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270-3221
Mailing Address - Country:US
Mailing Address - Phone:760-837-8767
Mailing Address - Fax:760-837-8806
Practice Address - Street 1:39000 BOB HOPE DR
Practice Address - Street 2:
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-3221
Practice Address - Country:US
Practice Address - Phone:760-837-8767
Practice Address - Fax:760-837-8806
Is Sole Proprietor?:No
Enumeration Date:2015-03-31
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1120801041C0700X
MA220609104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker