Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TB0200X | Cognitive & Behavioral Psychologist | PSY18058 | CA |
NPI | 1053075317 |
---|---|
Provider Name | Michelle Marie Lord |
First Address | Pasadena, CA 91107-4322 |
Second Address | Pasadena, CA 91107-4322 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/10/2021 |
Last Update Date | 23/10/2021 |