Basic Information
| Provider Information | |||||||||
| NPI: | 1265849871 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NEWCOMB | ||||||||
| FirstName: | MICHELLE | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LMFT #104721 | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | HAJENIAN | ||||||||
| OtherFirstName: | MICHELLE | ||||||||
| OtherMiddleName: | A | ||||||||
| OtherNamePrefix: | MS. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | MA, MFTI #IMF75048 | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 6957 N FIGUEROA ST | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 90042 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3234433175 | ||||||||
| FaxNumber: | 3234433265 | ||||||||
| Practice Location | |||||||||
| Address1: | 6957 N FIGUEROA ST | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 90042 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3234433175 | ||||||||
| FaxNumber: | 3234433265 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/15/2014 | ||||||||
| LastUpdateDate: | 02/23/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | IMF75048 | CA | N | Behavioral Health & Social Service Providers | Marriage & Family Therapist | 106H00000X | 104721 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.