Provider Demographics
NPI:1720645443
Name:VILLARREAL, MICHELE MARIE (MFT)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:MARIE
Last Name:VILLARREAL
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3470 QUAIL HAVEN LN
Mailing Address - Street 2:
Mailing Address - City:CARMICHAEL
Mailing Address - State:CA
Mailing Address - Zip Code:95608-3900
Mailing Address - Country:US
Mailing Address - Phone:916-425-8539
Mailing Address - Fax:
Practice Address - Street 1:720 SUNRISE AVE STE 200C
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-4508
Practice Address - Country:US
Practice Address - Phone:916-425-8539
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-29
Last Update Date:2019-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health