Healthcare Provider Details

I. General information

NPI: 1811359185
Provider Name (Legal Business Name): MICHELLE KOBAYASHI MA MFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2016
Last Update Date: 11/24/2025
Certification Date: 11/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1234 WILSHIRE BLVD APT 432
LOS ANGELES CA
90017-1982
US

IV. Provider business mailing address

1234 WILSHIRE BLVD APT 432
LOS ANGELES CA
90017-1982
US

V. Phone/Fax

Practice location:
  • Phone: 213-349-9335
  • Fax:
Mailing address:
  • Phone: 213-349-9335
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number91072
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: