MEDICARE: MICHELLE DE HARO LMFT

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
1	101YM0800X	Mental Health Counselor	142136	CA
2	106H00000X	Marriage & Family Therapist	142136	CA

General Provider Information

NPI Number	:	1184496580
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE DE HARO LMFT

Provider Business Mailing Address
First Line	:	9001 MENLO AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90044-4819
Country	:	US
Telephone Number	:	323-717-4724
Fax Number	:

Provider Business Practice Location Address
First Line	:	9001 MENLO AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90044-4819
Country	:	US
Telephone Number	:	323-717-4724
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/27/2023
Last Update Date	:	03/15/2024

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Directions to “ MICHELLE DE HARO LMFT” Practice Location

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