Provider Demographics
NPI:1790985042
Name:KESSLER, MICHAEL CHARLES CHRISTIAN
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:CHARLES CHRISTIAN
Last Name:KESSLER
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:MICKI
Other - Middle Name:ANN
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2227 CAPRICORN WAY STE 207
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95407-5486
Mailing Address - Country:US
Mailing Address - Phone:707-565-5006
Mailing Address - Fax:707-565-4907
Practice Address - Street 1:490 MENDOCINO AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95401-8530
Practice Address - Country:US
Practice Address - Phone:707-494-2974
Practice Address - Fax:415-565-4881
Is Sole Proprietor?:No
Enumeration Date:2007-07-24
Last Update Date:2021-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW24005101Y00000X
101Y00000X
CAASW 62549101YM0800X, 104100000X
CALCSW733681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker