Provider Demographics
NPI:1013203983
Name:EYNON, MICHELLE MARIE (LMFT)
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:MARIE
Last Name:EYNON
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:MRS
Other - First Name:MICHELLE
Other - Middle Name:MARIE
Other - Last Name:HAJAB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMFT
Mailing Address - Street 1:30767 GATEWAY PLACE
Mailing Address - Street 2:#619
Mailing Address - City:RANCHO MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92694
Mailing Address - Country:US
Mailing Address - Phone:310-739-7027
Mailing Address - Fax:
Practice Address - Street 1:9 ABARROTA ST
Practice Address - Street 2:
Practice Address - City:RANCHO MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92694
Practice Address - Country:US
Practice Address - Phone:949-371-6280
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-20
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA42124106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist