Provider Demographics
NPI:1083034730
Name:YORK, MICHELLE MARIE (LMFT)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:MARIE
Last Name:YORK
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:312 S CEDROS AVE
Mailing Address - Street 2:SUITE 334
Mailing Address - City:SOLANA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92075-1979
Mailing Address - Country:US
Mailing Address - Phone:760-613-2153
Mailing Address - Fax:
Practice Address - Street 1:312 S CEDROS AVE
Practice Address - Street 2:SUITE 334
Practice Address - City:SOLANA BEACH
Practice Address - State:CA
Practice Address - Zip Code:92075-1979
Practice Address - Country:US
Practice Address - Phone:760-613-2153
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-21
Last Update Date:2016-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA91175106H00000X
CAIMF 75209106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist