Provider Demographics
NPI:1003512203
Name:LI, MICHELLE ILENE (AMFT, APCC)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:ILENE
Last Name:LI
Suffix:
Gender:F
Credentials:AMFT, APCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2660 SOLACE PL STE D2
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94040-4337
Mailing Address - Country:US
Mailing Address - Phone:650-269-3660
Mailing Address - Fax:
Practice Address - Street 1:2660 SOLACE PL STE D2
Practice Address - Street 2:
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94040-4337
Practice Address - Country:US
Practice Address - Phone:650-269-3660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-31
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health