Provider Demographics
NPI:1760943021
Name:STANTON WHITE, MICHELLE THANH (LMFT)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:THANH
Last Name:STANTON WHITE
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:940 LA MESA DR
Mailing Address - Street 2:
Mailing Address - City:PORTOLA VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94028-7463
Mailing Address - Country:US
Mailing Address - Phone:650-854-9154
Mailing Address - Fax:
Practice Address - Street 1:500 ALLERTON ST
Practice Address - Street 2:STE 102
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94063-1545
Practice Address - Country:US
Practice Address - Phone:650-799-8597
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-28
Last Update Date:2019-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT105622106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist