Provider Demographics
NPI:1639580285
Name:GRUNSTEIN, MICHELLE (LMFT99291)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:GRUNSTEIN
Suffix:
Gender:F
Credentials:LMFT99291
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16200 VENTURA BLVD STE 406
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-4695
Mailing Address - Country:US
Mailing Address - Phone:323-559-2726
Mailing Address - Fax:
Practice Address - Street 1:16200 VENTURA BLVD STE 406
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-4695
Practice Address - Country:US
Practice Address - Phone:323-559-2726
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-16
Last Update Date:2020-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CA99291106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program