Provider Demographics
NPI:1265636930
Name:LLACH, MICHAEL (MFT)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:LLACH
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18826 CLEARBROOK ST
Mailing Address - Street 2:
Mailing Address - City:PORTER RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:91326-2127
Mailing Address - Country:US
Mailing Address - Phone:818-675-0268
Mailing Address - Fax:
Practice Address - Street 1:18826 CLEARBROOK ST
Practice Address - Street 2:
Practice Address - City:PORTER RANCH
Practice Address - State:CA
Practice Address - Zip Code:91326-2127
Practice Address - Country:US
Practice Address - Phone:818-831-9931
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-14
Last Update Date:2021-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC31727106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist