Provider Demographics
NPI:1083809693
Name:CHERRY, MICHELLE ROBERTS (MFT)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:ROBERTS
Last Name:CHERRY
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:NICOLE
Other - Last Name:ROBERTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:15951 LOS GATOS BLVD STE 13
Mailing Address - Street 2:
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032-3488
Mailing Address - Country:US
Mailing Address - Phone:408-384-8125
Mailing Address - Fax:408-402-8363
Practice Address - Street 1:15951 LOS GATOS BLVD STE 13
Practice Address - Street 2:
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-3488
Practice Address - Country:US
Practice Address - Phone:408-384-8125
Practice Address - Fax:408-402-8363
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-07
Last Update Date:2012-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50847106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist