Provider Demographics
NPI:1114585874
Name:SCHANLEY, MICHELE DIANE
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:DIANE
Last Name:SCHANLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9177 PATRICK AVE
Mailing Address - Street 2:
Mailing Address - City:ARLETA
Mailing Address - State:CA
Mailing Address - Zip Code:91331-4826
Mailing Address - Country:US
Mailing Address - Phone:818-371-4915
Mailing Address - Fax:
Practice Address - Street 1:223 N JACKSON ST
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91206-4334
Practice Address - Country:US
Practice Address - Phone:818-371-4915
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-29
Last Update Date:2019-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health