Provider Demographics
NPI:1588294987
Name:DIFALCO, MICHAEL ANTHONY (LMFT 141550)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:ANTHONY
Last Name:DIFALCO
Suffix:
Gender:M
Credentials:LMFT 141550
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:227 BARON AVE
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93612-1205
Mailing Address - Country:US
Mailing Address - Phone:559-940-2289
Mailing Address - Fax:
Practice Address - Street 1:4468 E CESAR CHAVEZ BLVD BLDG 340
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93702-3605
Practice Address - Country:US
Practice Address - Phone:559-600-6780
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-24
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA141550106H00000X
CA117384106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist