Basic Information
| Provider Information | |||||||||
| NPI: | 1629629563 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BOIRE | ||||||||
| FirstName: | JANETTE | ||||||||
| MiddleName: | LESLIE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4940 VAN NUYS BLVD STE 201 | ||||||||
| Address2: | |||||||||
| City: | SHERMAN OAKS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 914031700 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6263442012 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4940 VAN NUYS BLVD STE 201 | ||||||||
| Address2: | |||||||||
| City: | SHERMAN OAKS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 914031700 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8189850560 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/23/2019 | ||||||||
| LastUpdateDate: | 12/14/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 12/14/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | 118719 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.