Provider Demographics
NPI:1114654282
Name:LUJAN, MICHELLE ILENE (SUDRC)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:ILENE
Last Name:LUJAN
Suffix:
Gender:F
Credentials:SUDRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 W GABILAN ST
Mailing Address - Street 2:
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93901-2762
Mailing Address - Country:US
Mailing Address - Phone:831-422-6226
Mailing Address - Fax:831-422-6296
Practice Address - Street 1:165 CLAY ST
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93901-2509
Practice Address - Country:US
Practice Address - Phone:831-422-6226
Practice Address - Fax:831-422-6296
Is Sole Proprietor?:No
Enumeration Date:2022-08-08
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13791101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor