Healthcare Provider Details

I. General information

NPI: 1376306159
Provider Name (Legal Business Name): PALADIN PSYCHOTHERAPY & FAMILY COUNSELING, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2024
Last Update Date: 08/06/2025
Certification Date: 08/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20201 FAIRWEATHER ST
CANYON COUNTRY CA
91351-1050
US

IV. Provider business mailing address

19197 GOLDEN VALLEY RD # 842
CANYON COUNTRY CA
91387-1428
US

V. Phone/Fax

Practice location:
  • Phone: 661-655-2779
  • Fax:
Mailing address:
  • Phone: 661-655-2779
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: CARISSA ARIEL LATAILLADE
Title or Position: OWNER, CEO, PSYCHOTHERAPIST
Credential:
Phone: 661-655-2779