Healthcare Provider Details

I. General information

NPI: 1497096531
Provider Name (Legal Business Name): MICHELLE L DAVIDHOFF MFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/14/2013
Last Update Date: 03/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 S MCDONNELL AVE
COMMERCE CA
90040-5623
US

IV. Provider business mailing address

1500 S MCDONNELL AVE
COMMERCE CA
90040-5623
US

V. Phone/Fax

Practice location:
  • Phone: 323-981-4301
  • Fax:
Mailing address:
  • Phone: 323-981-4301
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: