Provider Demographics
NPI:1043700222
Name:MICHAEL PHILLIPS RICE LMFT
Entity type:Organization
Organization Name:MICHAEL PHILLIPS RICE LMFT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:RICE
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:530-559-4624
Mailing Address - Street 1:5470 RENO CORPORATE DR
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89511-2250
Mailing Address - Country:US
Mailing Address - Phone:775-657-0293
Mailing Address - Fax:
Practice Address - Street 1:204 W MAIN ST STE 119
Practice Address - Street 2:
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95945-4710
Practice Address - Country:US
Practice Address - Phone:530-559-4624
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-14
Last Update Date:2018-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA85668106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA85668OtherMFT