Healthcare Provider Details

I. General information

NPI: 1215861547
Provider Name (Legal Business Name): MICHELLE PSYCHOLOGY MAY PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2026
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1180 ROSECRANS ST STE 107
SAN DIEGO CA
92106-2660
US

IV. Provider business mailing address

1180 ROSECRANS ST STE 107
SAN DIEGO CA
92106-2660
US

V. Phone/Fax

Practice location:
  • Phone: 415-271-6447
  • Fax:
Mailing address:
  • Phone: 415-271-6447
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License NumberLEP3856
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: