Provider Demographics
NPI:1598506164
Name:STORY, MICHELLE RINCON
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:RINCON
Last Name:STORY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:
Other - Last Name:RINCON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:27651 STALLION SPRINGS DR
Mailing Address - Street 2:
Mailing Address - City:TEHACHAPI
Mailing Address - State:CA
Mailing Address - Zip Code:93561-5257
Mailing Address - Country:US
Mailing Address - Phone:619-646-0926
Mailing Address - Fax:
Practice Address - Street 1:410 W J ST STE A
Practice Address - Street 2:
Practice Address - City:TEHACHAPI
Practice Address - State:CA
Practice Address - Zip Code:93561-1411
Practice Address - Country:US
Practice Address - Phone:661-750-0438
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-05
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA146742106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist