Provider Demographics
NPI:1467675264
Name:DOUCETTE, MICHELLE NICOLE (LMFT90562)
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:NICOLE
Last Name:DOUCETTE
Suffix:
Gender:F
Credentials:LMFT90562
Other - Prefix:MS
Other - First Name:MICHELLE
Other - Middle Name:NICOLE
Other - Last Name:HOLT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:113 E F ST
Mailing Address - Street 2:
Mailing Address - City:TEHACHAPI
Mailing Address - State:CA
Mailing Address - Zip Code:93561-1710
Mailing Address - Country:US
Mailing Address - Phone:661-381-3413
Mailing Address - Fax:
Practice Address - Street 1:113 E F ST
Practice Address - Street 2:
Practice Address - City:TEHACHAPI
Practice Address - State:CA
Practice Address - Zip Code:93561-1710
Practice Address - Country:US
Practice Address - Phone:661-381-3413
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA90562106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00007473Medicaid
CA1467675264Medicaid
CA1467675264Medicaid