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General NPI Number Information
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NPI Number | 1326581471
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Entity Type | Individual
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Provider Name | MICHELLE MERCADO
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Gender | Female
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Dates
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Enumeration Date | 11/22/2016
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Last Update Date | 10/14/2021
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Provider Practice Location Address
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Address Line | 1328 2ND ST
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City | SANTA MONICA
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State | CA
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Zip | 90401
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Country | US
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Telephone | 310-394-6889
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Fax |
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Provider Business Mailing Address
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Address Line | 5535 WESTLAWN AVE APT 262
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City | LOS ANGELES
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State | CA
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Zip | 90066-7098
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Country | US
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Telephone |
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 105602
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | AMFT105602
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 127770
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License Number State | CA
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