Provider Demographics
NPI:1467187864
Name:PANDO, MICHELLE M (AMFT)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:M
Last Name:PANDO
Suffix:
Gender:F
Credentials:AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:657 LAUSINDA AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90803-2106
Mailing Address - Country:US
Mailing Address - Phone:909-200-9235
Mailing Address - Fax:
Practice Address - Street 1:3505 CADILLAC AVE # 109
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-1429
Practice Address - Country:US
Practice Address - Phone:714-432-9856
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-19
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling