=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285829739
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOAN MICHELLE WEISS M.F.T.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/07/2007
-----------------------------------------------------
Last Update Date | 02/24/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3675 GREENHILL RD
-----------------------------------------------------
City | PASADENA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91107-2107
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 626-510-9190
-----------------------------------------------------
Fax | 213-477-2189
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3675 GREENHILL RD
-----------------------------------------------------
City | PASADENA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91107-2107
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 626-510-9190
-----------------------------------------------------
Fax | 626-316-7241
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | MFC 11843
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------