Provider Demographics
NPI:1831404292
Name:MOUSTAKIS, MICHAEL LOWELL II
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:LOWELL
Last Name:MOUSTAKIS
Suffix:II
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 1:1616 29TH ST
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93301-1906
Mailing Address - Country:US
Mailing Address - Phone:661-326-8304
Mailing Address - Fax:661-326-8364
Practice Address - Street 1:1616 29TH ST
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93301-1906
Practice Address - Country:US
Practice Address - Phone:661-326-8304
Practice Address - Fax:661-326-8364
Is Sole Proprietor?:No
Enumeration Date:2010-08-10
Last Update Date:2010-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor