Provider Demographics
NPI:1790130961
Name:PEARCE, MICHELLE (LMFT)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:PEARCE
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:SHELLEY
Other - Middle Name:
Other - Last Name:PEARCE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMFT
Mailing Address - Street 1:2021 OCEAN AVE
Mailing Address - Street 2:SUITE # 202
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90405-1015
Mailing Address - Country:US
Mailing Address - Phone:310-310-5394
Mailing Address - Fax:
Practice Address - Street 1:2021 OCEAN AVE
Practice Address - Street 2:SUITE #202
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90405-1015
Practice Address - Country:US
Practice Address - Phone:310-310-5394
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-25
Last Update Date:2016-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC#84781106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist