Provider Demographics
NPI:1265849871
Name:NEWCOMB, MICHELLE A (LMFT #104721)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:A
Last Name:NEWCOMB
Suffix:
Gender:F
Credentials:LMFT #104721
Other - Prefix:MS
Other - First Name:MICHELLE
Other - Middle Name:A
Other - Last Name:HAJENIAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, MFTI #IMF75048
Mailing Address - Street 1:6957 N FIGUEROA ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90042
Mailing Address - Country:US
Mailing Address - Phone:323-443-3175
Mailing Address - Fax:323-443-3265
Practice Address - Street 1:6957 N FIGUEROA ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90042
Practice Address - Country:US
Practice Address - Phone:323-443-3175
Practice Address - Fax:323-443-3265
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-15
Last Update Date:2018-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF75048106H00000X
CA104721106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist