| Doctor Name: | MICHAEL HODSON STREET |
| NPI Number: | 1093872095 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | LCSW |
| License Number: | LCS 18551 |
| Business Practice Address: | 7000b S Center Dr Clearlake, CA - 954228131 |
| Business Phone Number: | 7075086412 |
| Business Fax Number: | 7072749192 |
| Mailing Address: | 6302 13th Ave, LUCERNE |
| State: | CA |
| Postal Code: | 95458 |
| Phone Number: | 7072749101 |
| Fax Number: | 7072749192 |
| NPI Enumeration Date: | 01/02/2007 |
| NPI Last Update Date: | 11/06/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | LCS 18551 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |