Provider Demographics
NPI:1699870006
Name:MCMICHAEL, HERBERT WALTER (PHD)
Entity type:Individual
Prefix:DR
First Name:HERBERT
Middle Name:WALTER
Last Name:MCMICHAEL
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:DR
Other - First Name:HERBERT
Other - Middle Name:WALTER SKYE
Other - Last Name:MCMICHAEL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:PO BOX 1426
Mailing Address - Street 2:
Mailing Address - City:PAUMA VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92061-1426
Mailing Address - Country:US
Mailing Address - Phone:760-742-2048
Mailing Address - Fax:951-487-9627
Practice Address - Street 1:11555 1/2 POTRERO RD
Practice Address - Street 2:MORONGO INDIAN RESERVATION
Practice Address - City:BANNING
Practice Address - State:CA
Practice Address - Zip Code:92220-6946
Practice Address - Country:US
Practice Address - Phone:800-732-8805
Practice Address - Fax:951-487-9627
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY12097103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical