Provider Demographics
NPI:1598947277
Name:BEHRENS, MICHAEL JOHN
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:JOHN
Last Name:BEHRENS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2952 BAY VILLAGE CIR
Mailing Address - Street 2:APT 2062
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95403-3625
Mailing Address - Country:US
Mailing Address - Phone:707-565-8686
Mailing Address - Fax:
Practice Address - Street 1:2952 BAY VILLAGE CIR
Practice Address - Street 2:APT 2062
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95403-3625
Practice Address - Country:US
Practice Address - Phone:707-565-8686
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-04
Last Update Date:2015-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health