Provider Demographics
NPI:1699580464
Name:MICHAEL, JESSE (APCC)
Entity type:Individual
Prefix:MR
First Name:JESSE
Middle Name:
Last Name:MICHAEL
Suffix:
Gender:M
Credentials:APCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:136 S CENTER
Mailing Address - Street 2:
Mailing Address - City:TURLOCK
Mailing Address - State:CA
Mailing Address - Zip Code:95380
Mailing Address - Country:US
Mailing Address - Phone:209-774-4235
Mailing Address - Fax:
Practice Address - Street 1:136 CENTER ST
Practice Address - Street 2:
Practice Address - City:TURLOCK
Practice Address - State:CA
Practice Address - Zip Code:95380
Practice Address - Country:US
Practice Address - Phone:209-774-4235
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-10
Last Update Date:2025-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health