Basic Information
| Provider Information | |||||||||
| NPI: | 1427475938 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JANESSIAN | ||||||||
| FirstName: | MAGGIE | ||||||||
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| Credential: | M.S., MFTI | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6346 RAYLENE CT | ||||||||
| Address2: | |||||||||
| City: | SIMI VALLEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 930634352 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8185905630 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 11600 ELDRIDGE AVE | ||||||||
| Address2: | |||||||||
| City: | LAKE VIEW TERRACE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913426506 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8186863000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/21/2014 | ||||||||
| LastUpdateDate: | 03/21/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | 71333 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.