Provider Demographics
NPI:1699703926
Name:GOMEZ, MICHELLE MARIE (PSY D)
Entity type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:MARIE
Last Name:GOMEZ
Suffix:
Gender:F
Credentials:PSY D
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:MARIE
Other - Last Name:GOMEZ ROMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PSYD
Mailing Address - Street 1:12204 DIANA NATALICIO DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-6882
Mailing Address - Country:US
Mailing Address - Phone:804-721-6657
Mailing Address - Fax:
Practice Address - Street 1:WBAMC
Practice Address - Street 2:18511 HIGHLAND MEDICS STREET
Practice Address - City:EL PASO
Practice Address - State:AA
Practice Address - Zip Code:79918
Practice Address - Country:US
Practice Address - Phone:915-742-9722
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR002482103TC0700X
PR2482103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical