Healthcare Provider Details

I. General information

NPI: 1386861961
Provider Name (Legal Business Name): MICHELE A GETZELMAN PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 08/31/2021
Certification Date: 08/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5757 WILSHIRE BLVD STE 439
LOS ANGELES CA
90036-3628
US

IV. Provider business mailing address

5757 WILSHIRE BLVD STE 439
LOS ANGELES CA
90036-3628
US

V. Phone/Fax

Practice location:
  • Phone: 310-579-9335
  • Fax: 310-579-9335
Mailing address:
  • Phone: 310-579-9335
  • Fax: 310-579-9335

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberPSY31861
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: