Healthcare Provider Details

I. General information

NPI: 1245845056
Provider Name (Legal Business Name): MISS MICHELLE NEMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2020
Last Update Date: 11/02/2022
Certification Date: 11/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 EL CAMINO DR STE 208
BEVERLY HILLS CA
90212-2723
US

IV. Provider business mailing address

120 EL CAMINO DR STE 208
BEVERLY HILLS CA
90212-2723
US

V. Phone/Fax

Practice location:
  • Phone: 310-351-8514
  • Fax:
Mailing address:
  • Phone: 424-257-0666
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number113655
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: