Provider Demographics
NPI:1316383326
Name:MACPHERSON, MICHELLE LOUISE
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:LOUISE
Last Name:MACPHERSON
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 1:4635 HIDALGO AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92117-2504
Mailing Address - Country:US
Mailing Address - Phone:858-270-0369
Mailing Address - Fax:
Practice Address - Street 1:4635 HIDALGO AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92117-2504
Practice Address - Country:US
Practice Address - Phone:858-270-0369
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-16
Last Update Date:2013-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA279991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical