Provider Demographics
NPI:1316229305
Name:PASAG, MICHELLE BANEZ (MFTI)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:BANEZ
Last Name:PASAG
Suffix:
Gender:F
Credentials:MFTI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12712 HAGERSWOOD CT
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92129-3707
Mailing Address - Country:US
Mailing Address - Phone:858-220-1545
Mailing Address - Fax:
Practice Address - Street 1:1202 MORENA BLVD
Practice Address - Street 2:SUITE 300
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92110-3841
Practice Address - Country:US
Practice Address - Phone:619-275-0822
Practice Address - Fax:619-275-5069
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-15
Last Update Date:2011-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health