Healthcare Provider Details

I. General information

NPI: 1144480377
Provider Name (Legal Business Name): MICHELLE LEE WATERHOUSE MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2008
Last Update Date: 06/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10929 SOUTH ST STE 208B
CERRITOS CA
90703-5368
US

IV. Provider business mailing address

10929 SOUTH ST STE 208B
CERRITOS CA
90703-5368
US

V. Phone/Fax

Practice location:
  • Phone: 562-924-5526
  • Fax: 562-924-1040
Mailing address:
  • Phone: 562-924-5526
  • Fax: 562-924-1040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: