Provider Demographics
NPI:1154130524
Name:MICHALKO, GEORGE BRIAN (LMFT)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:BRIAN
Last Name:MICHALKO
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5453 LEMON GROVE AVE APT 303
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90038-4099
Mailing Address - Country:US
Mailing Address - Phone:435-655-5900
Mailing Address - Fax:
Practice Address - Street 1:5453 LEMON GROVE AVE APT 303
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90038-4099
Practice Address - Country:US
Practice Address - Phone:435-655-5900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-31
Last Update Date:2024-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA150960106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist