Provider Demographics
NPI:1255582284
Name:MARKS, MICHELE M (LMFT)
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:M
Last Name:MARKS
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 1:6621 E PACIFIC COAST HWY STE 220
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90803-4239
Mailing Address - Country:US
Mailing Address - Phone:562-596-6322
Mailing Address - Fax:562-596-6664
Practice Address - Street 1:6621 E PACIFIC COAST HWY STE 220
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90803-4239
Practice Address - Country:US
Practice Address - Phone:562-596-6322
Practice Address - Fax:562-596-6664
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-08
Last Update Date:2008-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC39403106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist