Provider Demographics
NPI:1679881759
Name:MICKLE, TROY ALLEN (LMFT)
Entity Type:Individual
Prefix:MR
First Name:TROY
Middle Name:ALLEN
Last Name:MICKLE
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:MR
Other - First Name:TROY
Other - Middle Name:
Other - Last Name:MICKLE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMFT
Mailing Address - Street 1:2617 K ST STE 250
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816-5169
Mailing Address - Country:US
Mailing Address - Phone:279-895-4958
Mailing Address - Fax:
Practice Address - Street 1:2617 K ST STE 250
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-5169
Practice Address - Country:US
Practice Address - Phone:279-895-4958
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-22
Last Update Date:2024-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist