Provider Demographics
NPI:1881181949
Name:WILLIAMS, MICHELLE LEE (LMFT)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:LEE
Last Name:WILLIAMS
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 1:2386 COLLIER CT
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93065-2449
Mailing Address - Country:US
Mailing Address - Phone:808-358-9720
Mailing Address - Fax:
Practice Address - Street 1:360 MOBIL AVE STE 218B
Practice Address - Street 2:
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010-6374
Practice Address - Country:US
Practice Address - Phone:805-990-9533
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-15
Last Update Date:2020-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95041106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist