Provider Demographics
NPI:1598187429
Name:MICHAHELLES, THOMAS CHRISTOPH (LMFT)
Entity Type:Individual
Prefix:PROF
First Name:THOMAS
Middle Name:CHRISTOPH
Last Name:MICHAHELLES
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2901 SHATTUCK AVE
Mailing Address - Street 2:SUITE 'E'
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94705-1808
Mailing Address - Country:US
Mailing Address - Phone:510-649-9663
Mailing Address - Fax:510-842-1715
Practice Address - Street 1:2901 SHATTUCK AVE
Practice Address - Street 2:SUITE 'E'
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94705-1808
Practice Address - Country:US
Practice Address - Phone:510-649-9663
Practice Address - Fax:510-842-1715
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-12
Last Update Date:2016-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT23074106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA94-3098925OtherIRS