Provider Demographics
NPI:1154651412
Name:JANUS, MICAH LOUIS (PHD)
Entity Type:Individual
Prefix:DR
First Name:MICAH
Middle Name:LOUIS
Last Name:JANUS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30410 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:ORANGE BEACH
Mailing Address - State:AL
Mailing Address - Zip Code:36561-3774
Mailing Address - Country:US
Mailing Address - Phone:850-384-1943
Mailing Address - Fax:
Practice Address - Street 1:30410 RIVER RD
Practice Address - Street 2:
Practice Address - City:ORANGE BEACH
Practice Address - State:AL
Practice Address - Zip Code:36561-3774
Practice Address - Country:US
Practice Address - Phone:850-384-1943
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-10
Last Update Date:2013-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA000908103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist