Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YM0800X | Mental Health Counselor | ||
Y | 1041C0700X | Clinical Social Worker | 82606 | CA |
NPI | 1003224361 |
---|---|
Provider Name | Michelle Christine Cortez |
First Address | Glendora, CA 91740-2331 |
Second Address | West Covina, CA 91790-3001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/07/2014 |
Last Update Date | 16/07/2019 |