Provider Demographics
NPI:1861058356
Name:MIDDLEKAUFF, MICHELLE LEAH
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:LEAH
Last Name:MIDDLEKAUFF
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 1:40 COYOTE MOON TRAIL
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:CA
Mailing Address - Zip Code:95914
Mailing Address - Country:US
Mailing Address - Phone:530-679-0701
Mailing Address - Fax:530-679-0705
Practice Address - Street 1:40 COYOTE MOON TRAIL
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:CA
Practice Address - Zip Code:95914
Practice Address - Country:US
Practice Address - Phone:530-679-0701
Practice Address - Fax:530-679-0705
Is Sole Proprietor?:No
Enumeration Date:2019-05-10
Last Update Date:2019-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5863101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)