Provider Demographics
NPI:1932260908
Name:SALAZAR, MICHAEL (MED LPC TEXAS)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:
Last Name:SALAZAR
Suffix:
Gender:M
Credentials:MED LPC TEXAS
Other - Prefix:
Other - First Name:MIKE
Other - Middle Name:
Other - Last Name:SALAZAR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2298 AUDREY CT
Mailing Address - Street 2:
Mailing Address - City:FALLBROOK
Mailing Address - State:CA
Mailing Address - Zip Code:92028-5505
Mailing Address - Country:US
Mailing Address - Phone:602-930-3522
Mailing Address - Fax:
Practice Address - Street 1:14700 MANZANITA PARK ROAD
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:CA
Practice Address - Zip Code:92223-9222
Practice Address - Country:US
Practice Address - Phone:951-845-3155
Practice Address - Fax:951-922-6955
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5961101YP2500X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional