Provider Demographics
NPI:1346779592
Name:PAIR, MICHELLE DEANNE
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:DEANNE
Last Name:PAIR
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 1:1215 GRAND ST APT 1
Mailing Address - Street 2:
Mailing Address - City:ALAMEDA
Mailing Address - State:CA
Mailing Address - Zip Code:94501-4000
Mailing Address - Country:US
Mailing Address - Phone:510-759-7628
Mailing Address - Fax:
Practice Address - Street 1:2363 BOULEVARD CIR STE 2
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94595-1173
Practice Address - Country:US
Practice Address - Phone:510-759-7628
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-09
Last Update Date:2017-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41119106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist