Provider Demographics
NPI:1962878793
Name:ECONOMOU, MICHELE (MA)
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:
Last Name:ECONOMOU
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15300 VENTURA BLVD STE 301
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91403-5865
Mailing Address - Country:US
Mailing Address - Phone:818-681-9503
Mailing Address - Fax:
Practice Address - Street 1:15300 VENTURA BLVD STE 301
Practice Address - Street 2:
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91403-5865
Practice Address - Country:US
Practice Address - Phone:818-681-9503
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-16
Last Update Date:2015-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA84401106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist