Healthcare Provider Details

I. General information

NPI: 1376482398
Provider Name (Legal Business Name): MICHELLE MEYERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2026
Last Update Date: 03/26/2026
Certification Date: 03/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 RUBY DR
PLACENTIA CA
92870-4828
US

IV. Provider business mailing address

601 RUBY DR
PLACENTIA CA
92870-4828
US

V. Phone/Fax

Practice location:
  • Phone: 714-996-1921
  • Fax:
Mailing address:
  • Phone: 714-996-1921
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: