Provider Demographics
NPI:1821384793
Name:POBANZ, MICHAEL (PHD, LEP)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:
Last Name:POBANZ
Suffix:
Gender:M
Credentials:PHD, LEP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17915 ERWIN ST
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316-7109
Mailing Address - Country:US
Mailing Address - Phone:818-497-4142
Mailing Address - Fax:
Practice Address - Street 1:17915 ERWIN ST
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-7109
Practice Address - Country:US
Practice Address - Phone:818-497-4142
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-20
Last Update Date:2011-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALEP 2826103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool