Provider Demographics
NPI:1114227261
Name:NGUYEN, MICHELLE UYEN (LMFT)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:UYEN
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1777 HAMILTON AVE STE 210
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95125-5410
Mailing Address - Country:US
Mailing Address - Phone:408-266-8544
Mailing Address - Fax:408-266-8545
Practice Address - Street 1:1777 HAMILTON AVE STE 210
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95125-5410
Practice Address - Country:US
Practice Address - Phone:408-266-8544
Practice Address - Fax:408-266-8545
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-22
Last Update Date:2010-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC47285106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist