Provider Demographics
NPI:1295210672
Name:JAUREGUI, MYCHAEL (LMFT, LPCC)
Entity type:Individual
Prefix:
First Name:MYCHAEL
Middle Name:
Last Name:JAUREGUI
Suffix:
Gender:M
Credentials:LMFT, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 10781
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92711-0781
Mailing Address - Country:US
Mailing Address - Phone:510-335-0849
Mailing Address - Fax:
Practice Address - Street 1:39159 PASEO PADRE PKWY STE 121
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-1600
Practice Address - Country:US
Practice Address - Phone:510-952-1190
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-01
Last Update Date:2024-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA150398106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist