Provider Demographics
NPI:1710495726
Name:ISHIKAWA, MICHELE ELIZABETH (PHD)
Entity Type:Individual
Prefix:DR
First Name:MICHELE
Middle Name:ELIZABETH
Last Name:ISHIKAWA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3550 N CENTRAL AVE STE 1407
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-2112
Mailing Address - Country:US
Mailing Address - Phone:602-216-6900
Mailing Address - Fax:602-371-9889
Practice Address - Street 1:3550 N CENTRAL AVE STE 1407
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85012-2112
Practice Address - Country:US
Practice Address - Phone:602-216-6900
Practice Address - Fax:602-371-9889
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-12
Last Update Date:2018-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4904103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist