Basic Information
| Provider Information | |||||||||
| NPI: | 1649526484 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | WEST VALLEY COUNSELING CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 19634 VENTURA BLVD | ||||||||
| Address2: | SUITE 212 | ||||||||
| City: | TARZANA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913562966 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8187589450 | ||||||||
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| Practice Location | |||||||||
| Address1: | 19634 VENTURA BLVD | ||||||||
| Address2: | SUITE 212 | ||||||||
| City: | TARZANA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913562966 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8187589450 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/31/2012 | ||||||||
| LastUpdateDate: | 05/17/2013 | ||||||||
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| AuthorizedOfficialLastName: | BURNETT | ||||||||
| AuthorizedOfficialFirstName: | SHARON | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR CLINICAL SUPERVI | ||||||||
| AuthorizedOfficialTelephone: | 8187589450 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | WEST VALLEY COUNSELING CENTER | ||||||||
| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | PHD, MFT | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | MFT16203 | CA | Y | Agencies | Community/Behavioral Health |
No ID Information.