Provider Demographics
NPI:1740463579
Name:CAUGHLAN, MICHAEL P (MFT)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:P
Last Name:CAUGHLAN
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1427 EDLESBOROUGH CIR
Mailing Address - Street 2:
Mailing Address - City:GARDNERVILLE
Mailing Address - State:NV
Mailing Address - Zip Code:89410-5800
Mailing Address - Country:US
Mailing Address - Phone:775-220-0340
Mailing Address - Fax:
Practice Address - Street 1:603 E ROBINSON ST
Practice Address - Street 2:
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89701-4022
Practice Address - Country:US
Practice Address - Phone:775-883-4325
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-16
Last Update Date:2014-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVMFT 854106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist