Provider Demographics
NPI:1588270219
Name:MILLER, MICHELLE GUADALUPE (LMFT)
Entity type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:GUADALUPE
Last Name:MILLER
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:MS
Other - First Name:MICHELLE
Other - Middle Name:GUADALUPE
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMFT
Mailing Address - Street 1:1650 MISSION ST FL 5
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94103-2414
Mailing Address - Country:US
Mailing Address - Phone:415-355-3657
Mailing Address - Fax:
Practice Address - Street 1:1650 MISSION ST FL 5
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94103-2414
Practice Address - Country:US
Practice Address - Phone:415-355-3657
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-17
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA40411106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist