Provider Demographics
NPI:1770026791
Name:HORNGREN, MICHELLE LYNN (MS LMFT)
Entity Type:Individual
Prefix:MISS
First Name:MICHELLE
Middle Name:LYNN
Last Name:HORNGREN
Suffix:
Gender:F
Credentials:MS LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1058 GREYCLOUD LN
Mailing Address - Street 2:
Mailing Address - City:DIAMOND BAR
Mailing Address - State:CA
Mailing Address - Zip Code:91765-4219
Mailing Address - Country:US
Mailing Address - Phone:909-455-6996
Mailing Address - Fax:
Practice Address - Street 1:1058 GREYCLOUD LN
Practice Address - Street 2:
Practice Address - City:DIAMOND BAR
Practice Address - State:CA
Practice Address - Zip Code:91765-4219
Practice Address - Country:US
Practice Address - Phone:909-455-6996
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-22
Last Update Date:2021-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF#92306106H00000X
CALMFT113399106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist