Healthcare Provider Details

I. General information

NPI: 1265636930
Provider Name (Legal Business Name): MICHAEL LLACH M.F.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2007
Last Update Date: 12/22/2021
Certification Date: 12/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18826 CLEARBROOK ST
PORTER RANCH CA
91326-2127
US

IV. Provider business mailing address

18826 CLEARBROOK ST
PORTER RANCH CA
91326-2127
US

V. Phone/Fax

Practice location:
  • Phone: 818-831-9931
  • Fax:
Mailing address:
  • Phone: 818-675-0268
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC31727
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: