Provider Demographics
NPI:1538236518
Name:PROTHERO, MICHAEL WAYNE (MFT MA)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:WAYNE
Last Name:PROTHERO
Suffix:
Gender:M
Credentials:MFT MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:438 COLUSA AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:YUBA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95991
Mailing Address - Country:US
Mailing Address - Phone:530-755-0735
Mailing Address - Fax:530-755-0737
Practice Address - Street 1:438 COLUSA AVE
Practice Address - Street 2:SUITE A
Practice Address - City:YUBA CITY
Practice Address - State:CA
Practice Address - Zip Code:95991
Practice Address - Country:US
Practice Address - Phone:530-755-0735
Practice Address - Fax:530-755-0737
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC36329106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist