Provider Demographics
NPI:1356878748
Name:FELICIANO, MICHAEL LUIS (MFTI, PCCI)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:LUIS
Last Name:FELICIANO
Suffix:
Gender:M
Credentials:MFTI, PCCI
Other - Prefix:MR
Other - First Name:MICHAEL
Other - Middle Name:LUIS
Other - Last Name:FELICIANO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MFTI, PCCI
Mailing Address - Street 1:3637 MISSION AVE BLDG B
Mailing Address - Street 2:
Mailing Address - City:CARMICHAEL
Mailing Address - State:CA
Mailing Address - Zip Code:95608-2946
Mailing Address - Country:US
Mailing Address - Phone:916-485-4175
Mailing Address - Fax:
Practice Address - Street 1:9719 LINCOLN VILLAGE DR STE 300
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95827-3330
Practice Address - Country:US
Practice Address - Phone:916-485-4175
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF80927106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist