Provider Demographics
NPI:1285053850
Name:BERKLEY, MICHELL
Entity type:Individual
Prefix:
First Name:MICHELL
Middle Name:
Last Name:BERKLEY
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 1:5706 BOULDER CRK
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78724-3402
Mailing Address - Country:US
Mailing Address - Phone:512-803-0336
Mailing Address - Fax:
Practice Address - Street 1:5706 BOULDER CRK
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78724-3402
Practice Address - Country:US
Practice Address - Phone:512-803-0336
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-10
Last Update Date:2014-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management