Doctor Name: | MICHELLE BLUE |
NPI Number: | 1073910964 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | |
Business Practice Address: | 11642 Glenoaks Blvd Pacoima, CA - 913311068 |
Business Phone Number: | 8188972609 |
Business Fax Number: | 8188907159 |
Mailing Address: | 4760 Sepulveda Blvd, CULVER CITY |
State: | CA |
Postal Code: | 902304820 |
Phone Number: | 3103906612 |
Fax Number: | 3103985690 |
NPI Enumeration Date: | 11/20/2014 |
NPI Last Update Date: | 11/20/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YA0400X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Addiction (Substance Use Disorder) |
Taxonomy Definition: |