MEDICARE: MICHELLE GAGNON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	143959	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	01536011	OTHER		MEDICAL

General Provider Information

NPI Number	:	1063135937
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE GAGNON

Provider Business Mailing Address
First Line	:	8383 WILSHIRE BLVD STE 400
Second Line	:
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90211-2400
Country	:	US
Telephone Number	:	323-989-2302
Fax Number	:

Provider Business Practice Location Address
First Line	:	680 E COLORADO BLVD STE 180&2ND
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91101-6143
Country	:	US
Telephone Number	:	323-989-2302
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/26/2022
Last Update Date	:	06/05/2026

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Directions to “ MICHELLE GAGNON ” Practice Location

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