Provider Demographics
NPI:1992040133
Name:GHALI, MICHAEL N (PHD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:N
Last Name:GHALI
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6140 ASHTON PARK PL
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80919-4810
Mailing Address - Country:US
Mailing Address - Phone:239-560-2785
Mailing Address - Fax:239-561-9779
Practice Address - Street 1:1115 ELKTON DR STE 102
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-3597
Practice Address - Country:US
Practice Address - Phone:719-357-6471
Practice Address - Fax:719-434-9811
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-28
Last Update Date:2021-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY 8141103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist