Provider Demographics
NPI:1831312628
Name:LAU, MICHELLE WEI-SHAN IV (BPHE, BA, MAMFT)
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:WEI-SHAN
Last Name:LAU
Suffix:IV
Gender:F
Credentials:BPHE, BA, MAMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1625 E MAIN ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92021-5211
Mailing Address - Country:US
Mailing Address - Phone:619-441-1907
Mailing Address - Fax:
Practice Address - Street 1:1625 E MAIN ST
Practice Address - Street 2:SUITE 200
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92021-5211
Practice Address - Country:US
Practice Address - Phone:619-441-1907
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor