Provider Demographics
NPI:1093051260
Name:BECKER, MICHELLE (LMFT)
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:
Last Name:BECKER
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 1:15525 POMERADO RD STE C7
Mailing Address - Street 2:
Mailing Address - City:POWAY
Mailing Address - State:CA
Mailing Address - Zip Code:92064-2426
Mailing Address - Country:US
Mailing Address - Phone:858-748-6037
Mailing Address - Fax:
Practice Address - Street 1:15525 POMERADO RD STE C7
Practice Address - Street 2:
Practice Address - City:POWAY
Practice Address - State:CA
Practice Address - Zip Code:92064-2426
Practice Address - Country:US
Practice Address - Phone:858-748-6037
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-17
Last Update Date:2012-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC38600106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist