Provider Demographics
NPI:1295754737
Name:BROWN, MICHELE LYN (MA, LMFT)
Entity type:Individual
Prefix:MS
First Name:MICHELE
Middle Name:LYN
Last Name:BROWN
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:MS
Other - First Name:MICHELE
Other - Middle Name:LYN
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, LMFT
Mailing Address - Street 1:921 W AVENUE J STE C
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93534-3443
Mailing Address - Country:US
Mailing Address - Phone:323-541-3137
Mailing Address - Fax:
Practice Address - Street 1:921 W AVENUE J STE C
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-3443
Practice Address - Country:US
Practice Address - Phone:323-541-3137
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2020-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT37475106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist