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General NPI Number Information
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NPI Number | 1720633605
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Entity Type | Organization
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Legal Business Name | MICHELLE FALLAH PSYD CLINICAL PSYCHOLOGIST INC
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Dates
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Enumeration Date | 08/07/2019
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Last Update Date | 01/12/2023
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Provider Practice Location Address
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Address Line | 113 WATERWORKS WAY STE 245
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City | IRVINE
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State | CA
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Zip | 92618-3175
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Country | US
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Telephone | 949-299-9596
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Fax |
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Provider Business Mailing Address
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Address Line | 113 WATERWORKS WAY STE 245
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City | IRVINE
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State | CA
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Zip | 92618-3175
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Country | US
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Telephone | 949-299-9596
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Fax |
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Authorized Official
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Title or Position | OWNER, PRESIDENT
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Name | MICHELLE N. FALLAH
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Credential | PSYD
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Telephone | 949-299-9596
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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