Provider Demographics
NPI:1578844791
Name:LEBEAU, MICHELLE (LCSW 78436)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:LEBEAU
Suffix:
Gender:F
Credentials:LCSW 78436
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1404 BATH ST
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93101-3023
Mailing Address - Country:US
Mailing Address - Phone:805-708-8105
Mailing Address - Fax:
Practice Address - Street 1:924 ANACAPA ST STE 2I
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93101
Practice Address - Country:US
Practice Address - Phone:805-708-8105
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-01
Last Update Date:2018-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA784361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA78436OtherLCSW