Provider Demographics
NPI:1063437143
Name:MCGINNIS, MICHAEL PATRICK (MFT)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:PATRICK
Last Name:MCGINNIS
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 ALTA VISTA DR
Mailing Address - Street 2:
Mailing Address - City:HEALDSBURG
Mailing Address - State:CA
Mailing Address - Zip Code:95448-4651
Mailing Address - Country:US
Mailing Address - Phone:707-431-0500
Mailing Address - Fax:707-431-0500
Practice Address - Street 1:610 ALTA VISTA DR
Practice Address - Street 2:
Practice Address - City:HEALDSBURG
Practice Address - State:CA
Practice Address - Zip Code:95448-4651
Practice Address - Country:US
Practice Address - Phone:707-431-0500
Practice Address - Fax:707-431-0500
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2011-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20945106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist