Provider Demographics
NPI:1952445363
Name:DABACH, MICHELLE A (MFT)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:A
Last Name:DABACH
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:
Other - Last Name:DADOUN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MFT
Mailing Address - Street 1:23901 CALABASAS RD
Mailing Address - Street 2:SUITE 1078
Mailing Address - City:CALABASAS
Mailing Address - State:CA
Mailing Address - Zip Code:91302-1542
Mailing Address - Country:US
Mailing Address - Phone:323-614-9422
Mailing Address - Fax:
Practice Address - Street 1:15335 MORRISON ST STE 385
Practice Address - Street 2:
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91403-1571
Practice Address - Country:US
Practice Address - Phone:323-614-9422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-18
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 46732106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist