Provider Demographics
NPI:1215743406
Name:GHERLONE, MICHELLE FICKLING (LEP, LMFT, MA)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:FICKLING
Last Name:GHERLONE
Suffix:
Gender:F
Credentials:LEP, LMFT, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 FELIZ CT
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94526-1609
Mailing Address - Country:US
Mailing Address - Phone:949-291-9580
Mailing Address - Fax:
Practice Address - Street 1:185 FRONT ST STE 107B
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:CA
Practice Address - Zip Code:94526-3323
Practice Address - Country:US
Practice Address - Phone:949-291-9580
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-04
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA88191106H00000X
CA3456103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist