Provider Demographics
NPI:1073351615
Name:SAMIS, MICHELLE DIANE (LMFT23714)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:DIANE
Last Name:SAMIS
Suffix:
Gender:F
Credentials:LMFT23714
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:440 PALMER AVE
Mailing Address - Street 2:
Mailing Address - City:APTOS
Mailing Address - State:CA
Mailing Address - Zip Code:95003-5247
Mailing Address - Country:US
Mailing Address - Phone:831-818-8834
Mailing Address - Fax:
Practice Address - Street 1:440 PALMER AVE
Practice Address - Street 2:
Practice Address - City:APTOS
Practice Address - State:CA
Practice Address - Zip Code:95003-5247
Practice Address - Country:US
Practice Address - Phone:831-818-8834
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-17
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT23714101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health