Provider Demographics
NPI:1265079180
Name:FRIZZELLE, MICHELLE (LMFT)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:FRIZZELLE
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18442 THOMAS CT
Mailing Address - Street 2:
Mailing Address - City:ADELANTO
Mailing Address - State:CA
Mailing Address - Zip Code:92301-2268
Mailing Address - Country:US
Mailing Address - Phone:760-246-6809
Mailing Address - Fax:
Practice Address - Street 1:658 E BRIER DR
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92408-2880
Practice Address - Country:US
Practice Address - Phone:909-501-0730
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-10
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA132628106H00000X
CA111869106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist