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General NPI Number Information
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NPI Number | 1215743406
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Entity Type | Individual
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Provider Name | MICHELLE FICKLING GHERLONE LEP, LMFT, MA
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Gender | Female
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Dates
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Enumeration Date | 12/04/2024
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Last Update Date | 12/04/2024
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Provider Practice Location Address
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Address Line | 185 FRONT ST STE 107B
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City | DANVILLE
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State | CA
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Zip | 94526-3323
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Country | US
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Telephone | 949-291-9580
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Fax |
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Provider Business Mailing Address
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Address Line | 125 FELIZ CT
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City | DANVILLE
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State | CA
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Zip | 94526-1609
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Country | US
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Telephone | 949-291-9580
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 88191
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 3456
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License Number State | CA
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