Provider Demographics
NPI:1114329984
Name:OCEN, MICHELE AUDREY (PHD, BCBA)
Entity Type:Individual
Prefix:DR
First Name:MICHELE
Middle Name:AUDREY
Last Name:OCEN
Suffix:
Gender:F
Credentials:PHD, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:334 S MAIN ST
Mailing Address - Street 2:APT 1605
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90013-1357
Mailing Address - Country:US
Mailing Address - Phone:202-415-6308
Mailing Address - Fax:
Practice Address - Street 1:1120 W LA VETA AVE
Practice Address - Street 2:SUITE 470
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-4231
Practice Address - Country:US
Practice Address - Phone:202-415-6308
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-23
Last Update Date:2014-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX36759103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent