Healthcare Provider Details

I. General information

NPI: 1164103560
Provider Name (Legal Business Name): PAULA WHIDDEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2023
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18565 SOLEDAD CANYON RD # 270
CANYON COUNTRY CA
91351-3700
US

IV. Provider business mailing address

18565 SOLEDAD CANYON RD # 270
CANYON COUNTRY CA
91351-3700
US

V. Phone/Fax

Practice location:
  • Phone: 661-347-6644
  • Fax:
Mailing address:
  • Phone: 661-347-6644
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPCC22578
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT164631
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: