Provider Demographics
NPI:1629302336
Name:MACIEL, CHRISTIAN ANTHONY (LMFT)
Entity Type:Individual
Prefix:DR
First Name:CHRISTIAN
Middle Name:ANTHONY
Last Name:MACIEL
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:CHRISTIAN
Other - Middle Name:
Other - Last Name:MACIEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMFT
Mailing Address - Street 1:91275 66TH AVE
Mailing Address - Street 2:SUITE 500
Mailing Address - City:MECCA
Mailing Address - State:CA
Mailing Address - Zip Code:92254-6515
Mailing Address - Country:US
Mailing Address - Phone:760-396-1249
Mailing Address - Fax:760-396-1253
Practice Address - Street 1:91275 66TH AVE
Practice Address - Street 2:SUITE 500
Practice Address - City:MECCA
Practice Address - State:CA
Practice Address - Zip Code:92254-6515
Practice Address - Country:US
Practice Address - Phone:760-396-1249
Practice Address - Fax:760-396-1253
Is Sole Proprietor?:No
Enumeration Date:2009-09-28
Last Update Date:2020-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN35001725A106H00000X
CA49560106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist