Healthcare Provider Details

I. General information

NPI: 1043812159
Provider Name (Legal Business Name): TONJA MAHALLATI LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/12/2020
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9001 WILSHIRE BLVD STE 205
BEVERLY HILLS CA
90211-1840
US

IV. Provider business mailing address

9001 WILSHIRE BLVD STE 205
BEVERLY HILLS CA
90211-1840
US

V. Phone/Fax

Practice location:
  • Phone: 310-927-5900
  • Fax:
Mailing address:
  • Phone: 310-927-5900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number134436
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: