Provider Demographics
NPI:1548813355
Name:ATKINSON, MARIE-MICHELE MICHELE
Entity type:Individual
Prefix:
First Name:MARIE-MICHELE
Middle Name:MICHELE
Last Name:ATKINSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1345
Mailing Address - Street 2:
Mailing Address - City:TOPANGA
Mailing Address - State:CA
Mailing Address - Zip Code:90290-1345
Mailing Address - Country:US
Mailing Address - Phone:510-646-1410
Mailing Address - Fax:
Practice Address - Street 1:4807 SPICEWOOD SPRINGS RD BLDG 1
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-8444
Practice Address - Country:US
Practice Address - Phone:512-843-7665
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-20
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX204985106H00000X
CA124493106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF5554102OtherDRIVER'S LICENSE