Healthcare Provider Details

I. General information

NPI: 1104109735
Provider Name (Legal Business Name): MICHELLE MCWILLIAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2011
Last Update Date: 01/22/2026
Certification Date: 01/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6061 E KINGS CANYON SUITE 103 PMB 143
FRESNO CA
93727
US

IV. Provider business mailing address

6061 E KINGS CANYON ROAD STE 103 PMB 143
FRESNO CA
93727-3503
US

V. Phone/Fax

Practice location:
  • Phone: 559-238-7861
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number88874
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: