Provider Demographics
NPI:1467741140
Name:COULTER, MICHELLE E (BCBA)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:E
Last Name:COULTER
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2629 TOWNSGATE RD
Mailing Address - Street 2:SUITE 235
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91361-2990
Mailing Address - Country:US
Mailing Address - Phone:805-379-3212
Mailing Address - Fax:805-456-1627
Practice Address - Street 1:2629 TOWNSGATE RD
Practice Address - Street 2:SUITE 235
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91361-2990
Practice Address - Country:US
Practice Address - Phone:805-379-3212
Practice Address - Fax:805-456-1627
Is Sole Proprietor?:No
Enumeration Date:2011-04-01
Last Update Date:2013-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-05-2182103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst