Healthcare Provider Details

I. General information

NPI: 1073654372
Provider Name (Legal Business Name): EMILY JOANNE DAMIELLS MFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2007
Last Update Date: 01/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5675 TELEGRAPH RD STE. 200
COMMERCE CA
90040-1570
US

IV. Provider business mailing address

5675 TELEGRAPH RD STE. 200
COMMERCE CA
90040-1570
US

V. Phone/Fax

Practice location:
  • Phone: 323-838-9566
  • Fax: 323-838-9572
Mailing address:
  • Phone: 323-838-9566
  • Fax: 323-838-9572

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number52791
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: