Provider Demographics
NPI:1205025103
Name:BERNETT, MICHELLE JEANNE
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:JEANNE
Last Name:BERNETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 PINE ST STE 2
Mailing Address - Street 2:
Mailing Address - City:GALT
Mailing Address - State:CA
Mailing Address - Zip Code:95632-2055
Mailing Address - Country:US
Mailing Address - Phone:209-745-3101
Mailing Address - Fax:209-745-7539
Practice Address - Street 1:425 PINE ST STE 2
Practice Address - Street 2:
Practice Address - City:GALT
Practice Address - State:CA
Practice Address - Zip Code:95632-2055
Practice Address - Country:US
Practice Address - Phone:209-745-3101
Practice Address - Fax:209-745-7539
Is Sole Proprietor?:No
Enumeration Date:2007-10-17
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor