Provider Demographics
NPI:1578997045
Name:FAVIS, MICHELLE CORTES (MA/MFT INTERN)
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:CORTES
Last Name:FAVIS
Suffix:
Gender:F
Credentials:MA/MFT INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6233 SOQUEL DR
Mailing Address - Street 2:STE. C
Mailing Address - City:APTOS
Mailing Address - State:CA
Mailing Address - Zip Code:95003-3184
Mailing Address - Country:US
Mailing Address - Phone:831-251-6157
Mailing Address - Fax:
Practice Address - Street 1:6233 SOQUEL DR
Practice Address - Street 2:STE. C
Practice Address - City:APTOS
Practice Address - State:CA
Practice Address - Zip Code:95003-3184
Practice Address - Country:US
Practice Address - Phone:831-251-6157
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-02
Last Update Date:2014-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF 74741106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist