Provider Demographics
NPI:1336545060
Name:BELISLE, MICHELLE KUULANI (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:KUULANI
Last Name:BELISLE
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 1:40960 CALIFORNIA OAKS RD UNIT 851
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92562-5747
Mailing Address - Country:US
Mailing Address - Phone:951-290-0382
Mailing Address - Fax:951-290-3620
Practice Address - Street 1:24712 PANTERA CT
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562-4067
Practice Address - Country:US
Practice Address - Phone:951-290-0382
Practice Address - Fax:951-290-3620
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-06
Last Update Date:2022-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106H00000X
CA132315106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist