Healthcare Provider Details

I. General information

NPI: 1114329984
Provider Name (Legal Business Name): MICHELE AUDREY OCEN PH.D., BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2014
Last Update Date: 09/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 W LA VETA AVE SUITE 470
ORANGE CA
92868-4231
US

IV. Provider business mailing address

334 S MAIN ST APT 1605
LOS ANGELES CA
90013-1357
US

V. Phone/Fax

Practice location:
  • Phone: 202-415-6308
  • Fax:
Mailing address:
  • Phone: 202-415-6308
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number36759
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: