Provider Demographics
NPI:1376814871
Name:MICHAEL, JOSEPH WALTON (MS)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:WALTON
Last Name:MICHAEL
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 160
Mailing Address - Street 2:
Mailing Address - City:CORNING
Mailing Address - State:CA
Mailing Address - Zip Code:96021-0160
Mailing Address - Country:US
Mailing Address - Phone:530-570-5535
Mailing Address - Fax:
Practice Address - Street 1:741 MAIN ST
Practice Address - Street 2:SUITE 112
Practice Address - City:RED BLUFF
Practice Address - State:CA
Practice Address - Zip Code:96080-3359
Practice Address - Country:US
Practice Address - Phone:530-570-5535
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-16
Last Update Date:2012-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC41768106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist