Basic Information
| Provider Information | |||||||||
| NPI: | 1386778504 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BILOTTA-SMITH | ||||||||
| FirstName: | MICHELLE | ||||||||
| MiddleName: | S | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | PSY.D, LMFT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1311 CENTINELA AVE APT 8 | ||||||||
| Address2: | |||||||||
| City: | SANTA MONICA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 904042673 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3106636638 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1200 WILSHIRE BLVD STE 210 | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900171931 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2134811347 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/16/2007 | ||||||||
| LastUpdateDate: | 02/26/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | MFC41694 | CA | N | Behavioral Health & Social Service Providers | Marriage & Family Therapist | 103T00000X | PSY 24756 | CA | Y | Behavioral Health & Social Service Providers | Psychologist |
No ID Information.