Provider Demographics
NPI:1760997597
Name:JALEEL, MIKO MALEA (MA)
Entity Type:Individual
Prefix:
First Name:MIKO
Middle Name:MALEA
Last Name:JALEEL
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:MIKO
Other - Middle Name:MALEA
Other - Last Name:JALEEL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CCMA, CCAPP
Mailing Address - Street 1:1101 CAPP ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94110-4697
Mailing Address - Country:US
Mailing Address - Phone:415-821-1427
Mailing Address - Fax:415-821-1426
Practice Address - Street 1:1101 CAPP ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110-4697
Practice Address - Country:US
Practice Address - Phone:415-821-1427
Practice Address - Fax:415-821-1426
Is Sole Proprietor?:No
Enumeration Date:2017-12-01
Last Update Date:2017-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAR1282681117101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)