Provider Demographics
NPI:1508031923
Name:ERNST, MICHELE MARIE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MICHELE
Middle Name:MARIE
Last Name:ERNST
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2305
Mailing Address - Street 2:
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95617-2305
Mailing Address - Country:US
Mailing Address - Phone:530-661-9036
Mailing Address - Fax:
Practice Address - Street 1:34150 CANVAS BACK ST
Practice Address - Street 2:
Practice Address - City:WOODLAND
Practice Address - State:CA
Practice Address - Zip Code:95695-6018
Practice Address - Country:US
Practice Address - Phone:530-661-9036
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-26
Last Update Date:2008-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY18854103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical