1205078516 NPI number — MS. REINA M MICHELLE LMFT

Table of content: MS. REINA M MICHELLE LMFT (NPI 1205078516)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205078516 NPI number — MS. REINA M MICHELLE LMFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MICHELLE
Provider First Name:
REINA
Provider Middle Name:
M
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LMFT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GONZALES
Provider Other First Name:
REINS
Provider Other Middle Name:
M
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
L.M.F.T.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1205078516
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/17/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
408 EWELL CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
APTOS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95003-5234
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
831-662-3370
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
408 EWELL CT.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
APTOS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95003-5234
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
831-662-3370
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/01/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: FHC 40044F . This is a "MEDI-CAL GROUP PROVIDER #" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: ZZZ91892Z . This is a "MEDICARE GROUP PTAN#" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: ZZZ92069Z . This is a "MEDICARE GROUP PTAN#" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 120578516 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: FHC 70042F . This is a "MEDI-CAL GROUP PROVIDER #" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: ZZZ91891Z . This is a "MEDICARE GROUP PTAN#" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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