Healthcare Provider Details

I. General information

NPI: 1164270351
Provider Name (Legal Business Name): MICHELLE ASHLEY AGER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2024
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1103 N B ST STE D
SACRAMENTO CA
95811-0326
US

IV. Provider business mailing address

555 HARVEST PARK DRIVE SUITE B
BRENTWOOD CA
94513
US

V. Phone/Fax

Practice location:
  • Phone: 916-378-8266
  • Fax:
Mailing address:
  • Phone: 530-265-9057
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number158855
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: