Provider Demographics
NPI:1760535330
Name:THADEN, MICHAEL FREDRIC (LMFT, ATR, CHT)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:FREDRIC
Last Name:THADEN
Suffix:
Gender:M
Credentials:LMFT, ATR, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 164
Mailing Address - Street 2:
Mailing Address - City:ORANGEVALE
Mailing Address - State:CA
Mailing Address - Zip Code:95662-0164
Mailing Address - Country:US
Mailing Address - Phone:916-505-5092
Mailing Address - Fax:
Practice Address - Street 1:3550 WATT AVE
Practice Address - Street 2:SUITE 190
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95821-2667
Practice Address - Country:US
Practice Address - Phone:916-505-5092
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2013-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC34167101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional