Provider Demographics
NPI:1093315400
Name:THARPE, MICHAEL CHRISTIAN
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:CHRISTIAN
Last Name:THARPE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1914 22ND ST
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816-7109
Mailing Address - Country:US
Mailing Address - Phone:916-455-6258
Mailing Address - Fax:
Practice Address - Street 1:1914 22ND ST
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-7109
Practice Address - Country:US
Practice Address - Phone:916-455-6258
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-27
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA94-1582683101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)