MEDICARE: MICHELLE B MANDEL INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist

General Provider Information

NPI Number	:	1447627724
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MICHELLE B MANDEL INC

Provider Business Mailing Address
First Line	:	139 S BEVERLY DR
Second Line	:
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90212-3032
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	139 S BEVERLY DR
Second Line	:
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90212-3032
Country	:	US
Telephone Number	:	310-387-5850
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MICHELLE MANDEL
Credential	:
Telephone Number	:	310-387-5850

Provider Enumeration Date	:	08/21/2015
Last Update Date	:	08/21/2015

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