Provider Demographics
NPI:1811107188
Name:PEART, MICHAEL M
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:M
Last Name:PEART
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8743 PACIFIC HILLS WAY
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95828-5124
Mailing Address - Country:US
Mailing Address - Phone:510-499-6204
Mailing Address - Fax:
Practice Address - Street 1:8743 PACIFIC HILLS WAY
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95828-5124
Practice Address - Country:US
Practice Address - Phone:510-499-6204
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)