Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TA0700X | Adult Development & Aging Psychologist | PSY22300 | CA |
N | 103TB0200X | Cognitive & Behavioral Psychologist | PSY22300 | CA |
N | 103G00000X | Clinical Psychologist | PSY22300 | CA |
N | 103TC0700X | Clinical Psychologist | PSY22300 | CA |
Y | 103TP2701X | Group Psychotherapist | PSY22300 | CA |
NPI | 1801292974 |
---|---|
Provider Name | Michelle R. Ancharoff |
First Address | Los Alamitos, CA 90720 |
Second Address | Los Alamitos, CA 90720 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/11/2014 |
Last Update Date | 17/11/2014 |