Basic Information
| Provider Information | |||||||||
| NPI: | 1962038398 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RYAN | ||||||||
| FirstName: | MICHELE | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | MA, LMFT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 23777 MULHOLLAND HWY SPC 40 | ||||||||
| Address2: | |||||||||
| City: | CALABASAS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913023762 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7023490038 | ||||||||
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| Practice Location | |||||||||
| Address1: | 11565 LAUREL CANYON BLVD STE 116 | ||||||||
| Address2: | |||||||||
| City: | SAN FERNANDO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913404650 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8183615030 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/17/2020 | ||||||||
| LastUpdateDate: | 03/17/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/17/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | 118453 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.