Healthcare Provider Details

I. General information

NPI: 1144461690
Provider Name (Legal Business Name): BROAD HORIZONS MARRIAGE AND FAMILY COUNSELING, PROF. CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2009
Last Update Date: 03/24/2026
Certification Date: 03/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5923 KANAN RD
AGOURA HILLS CA
91301-1688
US

IV. Provider business mailing address

PO BOX 1410
TOPANGA CA
90290-1410
US

V. Phone/Fax

Practice location:
  • Phone: 310-866-2606
  • Fax: 310-455-1416
Mailing address:
  • Phone: 310-866-2606
  • Fax: 310-455-1416

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC42941
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: VERONICA SHEFTZ WINSTON
Title or Position: CEO, CFO
Credential: LMFT
Phone: 310-866-2606