Provider Demographics
NPI:1386955938
Name:BODWELL, MICHELLE LYNN DYCK (LMFT, ATR)
Entity type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:LYNN DYCK
Last Name:BODWELL
Suffix:
Gender:F
Credentials:LMFT, ATR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 S EUCLID AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101-2446
Mailing Address - Country:US
Mailing Address - Phone:626-390-8212
Mailing Address - Fax:
Practice Address - Street 1:130 S EUCLID AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-2446
Practice Address - Country:US
Practice Address - Phone:626-390-8212
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-29
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC42227106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist