Provider Demographics
NPI:1790802668
Name:PLUMMER, MICHAEL STEVEN (MFT)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:STEVEN
Last Name:PLUMMER
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:72 MOODY CT
Mailing Address - Street 2:201
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91360-6067
Mailing Address - Country:US
Mailing Address - Phone:805-777-3559
Mailing Address - Fax:
Practice Address - Street 1:72 MOODY CT
Practice Address - Street 2:201
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-6067
Practice Address - Country:US
Practice Address - Phone:805-777-3559
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC24607106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist