Provider Demographics
NPI:1215714878
Name:PUSEY, MICKESHA
Entity type:Individual
Prefix:
First Name:MICKESHA
Middle Name:
Last Name:PUSEY
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 1:530 SHOWERS DR STE 7-144
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94040-4740
Mailing Address - Country:US
Mailing Address - Phone:415-583-5046
Mailing Address - Fax:
Practice Address - Street 1:464 MOUNTAIN LAUREL CT
Practice Address - Street 2:
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94043-5502
Practice Address - Country:US
Practice Address - Phone:415-583-5046
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-08
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist