Provider Demographics
NPI:1609663996
Name:ARCHULETA, MICKI (PHD, MA, MED (2025))
Entity type:Individual
Prefix:
First Name:MICKI
Middle Name:
Last Name:ARCHULETA
Suffix:
Gender:
Credentials:PHD, MA, MED (2025)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1956 SHADOWBROOK DR
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95348-1435
Mailing Address - Country:US
Mailing Address - Phone:209-383-2520
Mailing Address - Fax:
Practice Address - Street 1:1956 SHADOWBROOK DR
Practice Address - Street 2:
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95348-1435
Practice Address - Country:US
Practice Address - Phone:209-383-2520
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-22
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health