Provider Demographics
NPI:1285826776
Name:JANI, MICHELLE SHALU (MFT)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:SHALU
Last Name:JANI
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2450 S ATLANTIC BLVD
Mailing Address - Street 2:#101
Mailing Address - City:COMMERCE
Mailing Address - State:CA
Mailing Address - Zip Code:90040-1200
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2450 S ATLANTIC BLVD
Practice Address - Street 2:#101
Practice Address - City:COMMERCE
Practice Address - State:CA
Practice Address - Zip Code:90040-1200
Practice Address - Country:US
Practice Address - Phone:323-318-9960
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-17
Last Update Date:2012-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA44194106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA#95-2633765OtherMEDI-CAL