Basic Information
| Provider Information | |||||||||
| NPI: | 1861092314 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MEJIA | ||||||||
| FirstName: | VIVIAN | ||||||||
| MiddleName: | ANAIZ | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10919 SEPULVEDA BLVD UNIT 7803 | ||||||||
| Address2: | |||||||||
| City: | MISSION HILLS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913465036 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8183589648 | ||||||||
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| Practice Location | |||||||||
| Address1: | 11631 VICTORY BLVD STE 203 | ||||||||
| Address2: | |||||||||
| City: | NORTH HOLLYWOOD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 916063572 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8189083855 | ||||||||
| FaxNumber: | 8187535265 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/26/2020 | ||||||||
| LastUpdateDate: | 01/27/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/27/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health | 106H00000X | N | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.