Provider Demographics
NPI:1205480357
Name:DEAN, MICHAEL (MAS-MFT, LMFT)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:DEAN
Suffix:
Gender:M
Credentials:MAS-MFT, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:631 W PORTOBELLO AVE
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85210-8347
Mailing Address - Country:US
Mailing Address - Phone:480-748-8616
Mailing Address - Fax:
Practice Address - Street 1:16815 S DESERT FOOTHILLS PKWY STE 134
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85048-8465
Practice Address - Country:US
Practice Address - Phone:602-550-5221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-27
Last Update Date:2019-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLMFT-15210106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist