Provider Demographics
NPI:1184868820
Name:LYSAGHT, MICHAEL PATRICK (LMFT)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:PATRICK
Last Name:LYSAGHT
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1919 21ST ST STE 207
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95811-6827
Mailing Address - Country:US
Mailing Address - Phone:415-205-2788
Mailing Address - Fax:408-384-5070
Practice Address - Street 1:1919 21ST ST STE 207
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95811-6827
Practice Address - Country:US
Practice Address - Phone:415-205-2788
Practice Address - Fax:408-384-5070
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-24
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC77671106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist