Provider Demographics
NPI:1699114181
Name:QUINTANILLA, MICHELLE (LAMFT)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:QUINTANILLA
Suffix:
Gender:F
Credentials:LAMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6124 FASHION ST
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79932-2107
Mailing Address - Country:US
Mailing Address - Phone:915-490-4354
Mailing Address - Fax:
Practice Address - Street 1:4470 W SUNSET BLVD STE 107
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027
Practice Address - Country:US
Practice Address - Phone:323-798-7413
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-18
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106480106H00000X
CA10054668106H00000X
NMCTL0197361106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist