Provider Demographics
NPI:1538248174
Name:MICKELIS, ANGELA M (PHD)
Entity type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:M
Last Name:MICKELIS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23541 SKY VIEW TER
Mailing Address - Street 2:
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95033-9210
Mailing Address - Country:US
Mailing Address - Phone:650-238-4959
Mailing Address - Fax:408-353-6053
Practice Address - Street 1:257 CASTRO ST STE 218
Practice Address - Street 2:
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94041-1287
Practice Address - Country:US
Practice Address - Phone:650-238-4959
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist