Provider Demographics
NPI:1083793335
Name:FRITCH, MICHAEL ALAN (MFT)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:ALAN
Last Name:FRITCH
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 SOUTHAMPTON ROAD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:BENICIA
Mailing Address - State:CA
Mailing Address - Zip Code:94510-2221
Mailing Address - Country:US
Mailing Address - Phone:707-208-5916
Mailing Address - Fax:707-428-6774
Practice Address - Street 1:1125 MISSOURI ST
Practice Address - Street 2:SUITE 202
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94533-6088
Practice Address - Country:US
Practice Address - Phone:707-208-5916
Practice Address - Fax:707-428-6774
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC39822106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist