Provider Demographics
NPI:1174816540
Name:FOGLE, MICHELLE GARBER (MFT)
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:GARBER
Last Name:FOGLE
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:MARIE
Other - Last Name:GARBER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MFT
Mailing Address - Street 1:216 W LOS ANGELES DR
Mailing Address - Street 2:
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92083-3101
Mailing Address - Country:US
Mailing Address - Phone:760-630-4035
Mailing Address - Fax:
Practice Address - Street 1:216 W LOS ANGELES DR
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92083-3101
Practice Address - Country:US
Practice Address - Phone:760-630-4035
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-18
Last Update Date:2011-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC27810106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist