Provider Demographics
NPI:1477238327
Name:ARTEAGA, MIKE ENMANUEL (AMFT)
Entity Type:Individual
Prefix:
First Name:MIKE
Middle Name:ENMANUEL
Last Name:ARTEAGA
Suffix:
Gender:M
Credentials:AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 N REINO RD # 1037
Mailing Address - Street 2:
Mailing Address - City:NEWBURY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91320-3710
Mailing Address - Country:US
Mailing Address - Phone:818-665-9701
Mailing Address - Fax:805-917-6861
Practice Address - Street 1:100 E THOUSAND OAKS BLVD STE 231
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-8175
Practice Address - Country:US
Practice Address - Phone:805-917-6860
Practice Address - Fax:805-917-6861
Is Sole Proprietor?:No
Enumeration Date:2023-06-19
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA131008101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health