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General NPI Number Information
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NPI Number | 1689228371
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Entity Type | Individual
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Provider Name | STEPHANIE AIDA MICHAELIAN
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Gender | Female
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Dates
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Enumeration Date | 07/30/2019
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Last Update Date | 07/30/2019
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Provider Practice Location Address
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Address Line | 223 N JACKSON ST
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City | GLENDALE
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State | CA
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Zip | 91206-4380
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Country | US
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Telephone | 818-241-3111
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1171
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City | GLENDALE
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State | CA
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Zip | 91209-1171
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Country | US
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Telephone | 323-422-0744
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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