Provider Demographics
NPI:1831648310
Name:BRITT, MIKAL
Entity Type:Individual
Prefix:
First Name:MIKAL
Middle Name:
Last Name:BRITT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 E FOOTHILL BLVD
Mailing Address - Street 2:STE 102
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91006-2361
Mailing Address - Country:US
Mailing Address - Phone:626-701-4249
Mailing Address - Fax:626-701-4249
Practice Address - Street 1:41 E FOOTHILL BLVD
Practice Address - Street 2:STE 102
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91006-2361
Practice Address - Country:US
Practice Address - Phone:626-701-4249
Practice Address - Fax:626-737-6034
Is Sole Proprietor?:No
Enumeration Date:2016-09-26
Last Update Date:2021-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CAASW77423104100000X
CA950001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No104100000XBehavioral Health & Social Service ProvidersSocial Worker