Provider Demographics
NPI:1447314588
Name:MICHALIS, CYNTHIA BROOKS (MFT)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:BROOKS
Last Name:MICHALIS
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 CAMINO ALTO CT
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MILL VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94941-4312
Mailing Address - Country:US
Mailing Address - Phone:415-455-5476
Mailing Address - Fax:415-721-7747
Practice Address - Street 1:205 CAMINO ALTO CT
Practice Address - Street 2:SUITE 200
Practice Address - City:MILL VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94941-4312
Practice Address - Country:US
Practice Address - Phone:415-455-5476
Practice Address - Fax:415-721-7747
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC32017106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist