Provider Demographics
NPI:1750832937
Name:PARDUE, MACHELLE
Entity type:Individual
Prefix:
First Name:MACHELLE
Middle Name:
Last Name:PARDUE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4082 VALETA ST UNIT 361
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92110-5823
Mailing Address - Country:US
Mailing Address - Phone:619-609-4937
Mailing Address - Fax:
Practice Address - Street 1:1400 PARKMOOR AVE
Practice Address - Street 2:SUITE 115
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95126-3797
Practice Address - Country:US
Practice Address - Phone:408-971-9822
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-21
Last Update Date:2024-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
CA1213701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor