Provider Demographics
NPI:1013149541
Name:WONDERS, MICHELLE CHRISTINE (MS,MFT)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:CHRISTINE
Last Name:WONDERS
Suffix:
Gender:F
Credentials:MS,MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5301 MISSION OAKS BLVD
Mailing Address - Street 2:SUITE C
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93012-5406
Mailing Address - Country:US
Mailing Address - Phone:805-482-7724
Mailing Address - Fax:
Practice Address - Street 1:5301 MISSION OAKS BLVD
Practice Address - Street 2:SUITE C
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93012-5406
Practice Address - Country:US
Practice Address - Phone:805-482-7724
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-18
Last Update Date:2009-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT29818106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist