Provider Demographics
NPI:1295016962
Name:MICHEL, ELLEN ARTHUR (MA, LMFT)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:ARTHUR
Last Name:MICHEL
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11150 W OLYMPIC BLVD STE 760
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90064-1855
Mailing Address - Country:US
Mailing Address - Phone:310-383-5148
Mailing Address - Fax:
Practice Address - Street 1:11150 W OLYMPIC BLVD STE 760
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90064-1855
Practice Address - Country:US
Practice Address - Phone:310-383-5148
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-07
Last Update Date:2015-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIM 68304101YM0800X
CA79273106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health