Provider Demographics
NPI:1245759950
Name:BAIRD, MICHELLE CORINNE (AMFT)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:CORINNE
Last Name:BAIRD
Suffix:
Gender:F
Credentials:AMFT
Other - Prefix:MISS
Other - First Name:MICHELLE
Other - Middle Name:CORINNE
Other - Last Name:HUNT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4250 FOWLER LN STE 204
Mailing Address - Street 2:
Mailing Address - City:DIAMOND SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:95619-9782
Mailing Address - Country:US
Mailing Address - Phone:530-295-1491
Mailing Address - Fax:
Practice Address - Street 1:4250 FOWLER LN STE 204
Practice Address - Street 2:
Practice Address - City:DIAMOND SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:95619-9782
Practice Address - Country:US
Practice Address - Phone:530-626-3105
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-13
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA150057106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist