Provider Demographics
NPI:1205902954
Name:SLOAN, MICHAEL P (PHD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:P
Last Name:SLOAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:264 N HIGHLAND SPRINGS AVE
Mailing Address - Street 2:STE 1C
Mailing Address - City:BANNING
Mailing Address - State:CA
Mailing Address - Zip Code:92220-3045
Mailing Address - Country:US
Mailing Address - Phone:951-845-8262
Mailing Address - Fax:951-845-6458
Practice Address - Street 1:264 N HIGHLAND SPRINGS AVE
Practice Address - Street 2:STE 1C
Practice Address - City:BANNING
Practice Address - State:CA
Practice Address - Zip Code:92220-3045
Practice Address - Country:US
Practice Address - Phone:951-845-8262
Practice Address - Fax:951-845-6458
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-27
Last Update Date:2017-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY8604103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY086040Medicaid
CAPSY086040Medicaid
00PL86041Medicare ID - Type Unspecified