Provider Demographics
NPI:1740558253
Name:MICHELLE CONOVER PHD A PSYCHOLOGICAL CORPORATION
Entity Type:Organization
Organization Name:MICHELLE CONOVER PHD A PSYCHOLOGICAL CORPORATION
Other - Org Name:SOUTHERN CALIFORNIA NEUROPSYCHOLOGY GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:CONOVER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:818-340-7700
Mailing Address - Street 1:6200 CANOGA AVE STE 210
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91367-7794
Mailing Address - Country:US
Mailing Address - Phone:818-340-7700
Mailing Address - Fax:818-340-7701
Practice Address - Street 1:5950 CANOGA AVE STE 100
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91367-5052
Practice Address - Country:US
Practice Address - Phone:818-340-7700
Practice Address - Fax:818-340-7701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-12
Last Update Date:2023-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY21871103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty