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General NPI Number Information
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NPI Number | 1225883358
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Entity Type | Organization
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Legal Business Name | MICHELLE CANTRELL LICENSED PROFESSIONAL CLINICAL COUNSELING INC
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Dates
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Enumeration Date | 04/22/2024
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Last Update Date | 04/22/2024
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Provider Practice Location Address
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Address Line | 595 E COLORADO BLVD STE 205
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City | PASADENA
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State | CA
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Zip | 91101-2028
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Country | US
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Telephone | 602-702-3485
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Fax |
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Provider Business Mailing Address
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Address Line | 1563 SCENIC DR
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City | PASADENA
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State | CA
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Zip | 91103-1937
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Country | US
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Telephone | 571-969-4393
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Fax | 571-969-4393
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Authorized Official
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Title or Position | CEO
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Name | MICHELLE D CANTRELL
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Credential | M.ED., LPCC
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Telephone | 571-969-4393
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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