Provider Demographics
NPI:1386136653
Name:BLATNIK, MICHELLE L (MS, LMFT)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:L
Last Name:BLATNIK
Suffix:
Gender:F
Credentials:MS, LMFT
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:L
Other - Last Name:FOLTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:27001 LA PAZ RD STE 430C
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-5530
Mailing Address - Country:US
Mailing Address - Phone:949-415-6520
Mailing Address - Fax:
Practice Address - Street 1:27001 LA PAZ RD STE 430C
Practice Address - Street 2:
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-5530
Practice Address - Country:US
Practice Address - Phone:949-415-6520
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-03
Last Update Date:2018-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA105873106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist