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NPI Code Detail

MEDICARE: MICHELE DIANE SCHANLEY

MEDICARE: MICHELE DIANE SCHANLEY
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1114585874
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHELE DIANE SCHANLEY
Provider Business Mailing Address
First Line : 9177 PATRICK AVE
Second Line :
City : ARLETA
State : CA
Zip : 91331-4826
Country : US
Telephone Number : 818-371-4915
Fax Number :
Provider Business Practice Location Address
First Line : 223 N JACKSON ST
Second Line :
City : GLENDALE
State : CA
Zip : 91206-4334
Country : US
Telephone Number : 818-371-4915
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/29/2019
Last Update Date : 05/29/2019

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Directions to “ MICHELE DIANE SCHANLEY ” Practice Location

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