Healthcare Provider Details

I. General information

NPI: 1326929589
Provider Name (Legal Business Name): MICHELLE RENE KING PPS-SC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2025
Last Update Date: 09/11/2025
Certification Date: 09/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 W STANFORD RANCH RD
ROCKLIN CA
95765-3811
US

IV. Provider business mailing address

6235 SILVERTON WAY
CARMICHAEL CA
95608-0758
US

V. Phone/Fax

Practice location:
  • Phone: 916-934-4395
  • Fax:
Mailing address:
  • Phone: 916-934-4395
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-12-12582
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: