Provider Demographics
NPI:1447624101
Name:GLEESON, MICHAELA
Entity type:Individual
Prefix:
First Name:MICHAELA
Middle Name:
Last Name:GLEESON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45691 MONROE ST
Mailing Address - Street 2:1
Mailing Address - City:INDIO
Mailing Address - State:CA
Mailing Address - Zip Code:92201-3939
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:45691 MONROE ST
Practice Address - Street 2:1
Practice Address - City:INDIO
Practice Address - State:CA
Practice Address - Zip Code:92201-3939
Practice Address - Country:US
Practice Address - Phone:760-600-2709
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-18
Last Update Date:2015-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor