Provider Demographics
NPI:1265611677
Name:MARVEL, MICHAEL GARY (MA MHC)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:GARY
Last Name:MARVEL
Suffix:
Gender:M
Credentials:MA MHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24224 4TH PL W
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98021-8641
Mailing Address - Country:US
Mailing Address - Phone:425-488-3155
Mailing Address - Fax:
Practice Address - Street 1:24224 4TH PL W
Practice Address - Street 2:
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98021-8641
Practice Address - Country:US
Practice Address - Phone:425-488-3155
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-01
Last Update Date:2010-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional