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General NPI Number Information
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NPI Number | 1538043641
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Entity Type | Individual
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Provider Name | MOLLY MICHAELS
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Gender | Female
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Dates
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Enumeration Date | 08/01/2025
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Last Update Date | 08/01/2025
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Provider Practice Location Address
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Address Line | 700 EL CAMINO REAL STE 120
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City | MENLO PARK
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State | CA
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Zip | 94025-4884
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Country | US
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Telephone | 650-204-1246
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Fax |
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Provider Business Mailing Address
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Address Line | 3960 LONG HOLLOW RD
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City | ROANOKE
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State | TX
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Zip | 76262-3830
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Country | US
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Telephone | 906-286-0088
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 94029065
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License Number State | CA
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