Provider Demographics
NPI:1992436695
Name:FRASE, MICHELLE
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:FRASE
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:
Other - Last Name:ERLICHMAN, PONTILLAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:180 PROMENADE CIR STE 220
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95834-2922
Mailing Address - Country:US
Mailing Address - Phone:916-642-7808
Mailing Address - Fax:888-870-9642
Practice Address - Street 1:180 PROMENADE CIR STE 220
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95834-2922
Practice Address - Country:US
Practice Address - Phone:916-642-7808
Practice Address - Fax:888-870-9642
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-22
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No172V00000XOther Service ProvidersCommunity Health Worker