Provider Demographics
NPI:1750402897
Name:BRINTLE, MICHELE RENE (MFT)
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:RENE
Last Name:BRINTLE
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:MICHELE
Other - Middle Name:RENE
Other - Last Name:PEARSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:344 PLACERVILLE DR STE 17
Mailing Address - Street 2:
Mailing Address - City:PLACERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95667-3972
Mailing Address - Country:US
Mailing Address - Phone:530-621-6343
Mailing Address - Fax:
Practice Address - Street 1:344 PLACERVILLE DR STE 17
Practice Address - Street 2:
Practice Address - City:PLACERVILLE
Practice Address - State:CA
Practice Address - Zip Code:95667-3972
Practice Address - Country:US
Practice Address - Phone:530-621-6343
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC34761106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist