Provider Demographics
NPI:1265451132
Name:BEHLES, MICHAEL W (PHD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:W
Last Name:BEHLES
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 1:685 E K ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:BENICIA
Mailing Address - State:CA
Mailing Address - Zip Code:94510-3508
Mailing Address - Country:US
Mailing Address - Phone:818-424-0990
Mailing Address - Fax:877-669-1468
Practice Address - Street 1:1447 4TH ST
Practice Address - Street 2:SUITE C
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94559-2805
Practice Address - Country:US
Practice Address - Phone:818-424-0990
Practice Address - Fax:877-669-1468
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2017-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY4517103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical