Provider Demographics
NPI:1871860064
Name:KREZANOSKI, MICHELLE FRANCES (MFT)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:FRANCES
Last Name:KREZANOSKI
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 SOQUEL AVE
Mailing Address - Street 2:#206 H
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95062-2336
Mailing Address - Country:US
Mailing Address - Phone:831-854-7307
Mailing Address - Fax:
Practice Address - Street 1:555 SOQUEL AVE
Practice Address - Street 2:#206 H
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95062-2336
Practice Address - Country:US
Practice Address - Phone:831-854-7307
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-16
Last Update Date:2013-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC52664106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist