Provider Demographics
NPI:1306164207
Name:MILLER, MICHELLE LEIGH (MFT)
Entity type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:LEIGH
Last Name:MILLER
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23421 S POINTE DR STE 130
Mailing Address - Street 2:
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-1554
Mailing Address - Country:US
Mailing Address - Phone:949-429-6743
Mailing Address - Fax:
Practice Address - Street 1:23421 S POINTE DR STE 130
Practice Address - Street 2:
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-1554
Practice Address - Country:US
Practice Address - Phone:949-429-6743
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-17
Last Update Date:2010-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 36209106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist