Provider Demographics
NPI:1720633605
Name:MICHELLE FALLAH PSYD CLINICAL PSYCHOLOGIST INC
Entity Type:Organization
Organization Name:MICHELLE FALLAH PSYD CLINICAL PSYCHOLOGIST INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:N
Authorized Official - Last Name:FALLAH
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:949-299-9596
Mailing Address - Street 1:113 WATERWORKS WAY STE 245
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-3175
Mailing Address - Country:US
Mailing Address - Phone:949-299-9596
Mailing Address - Fax:
Practice Address - Street 1:113 WATERWORKS WAY STE 245
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-3175
Practice Address - Country:US
Practice Address - Phone:949-299-9596
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-07
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty