Provider Demographics
NPI:1891485868
Name:MICHELLE GASPER PROFESSIONAL CLINICAL COUNSELOR CANVAS COUNSELING CENT
Entity Type:Organization
Organization Name:MICHELLE GASPER PROFESSIONAL CLINICAL COUNSELOR CANVAS COUNSELING CENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO, THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:J
Authorized Official - Last Name:GASPER
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT LPCC
Authorized Official - Phone:909-240-0419
Mailing Address - Street 1:4091 RIVERSIDE DR STE 103
Mailing Address - Street 2:
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91710-3195
Mailing Address - Country:US
Mailing Address - Phone:909-654-8079
Mailing Address - Fax:
Practice Address - Street 1:4091 RIVERSIDE DR STE 103
Practice Address - Street 2:
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710-3195
Practice Address - Country:US
Practice Address - Phone:909-654-8079
Practice Address - Fax:909-774-0142
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-11
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty