Healthcare Provider Details

I. General information

NPI: 1255962338
Provider Name (Legal Business Name): PHOEBE PANTALEON-FATHALLAH LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: PHOEBE PANTALEON LMFT

II. Dates (important events)

Enumeration Date: 01/28/2020
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

440 N BARRANCA AVE # 4445
COVINA CA
91723-1722
US

IV. Provider business mailing address

440 N BARRANCA AVE # 4445
COVINA CA
91723-1722
US

V. Phone/Fax

Practice location:
  • Phone: 424-625-5561
  • Fax:
Mailing address:
  • Phone: 424-625-5561
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberAMFT126592
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number0717002572
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number141555
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberR1381670320
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberTPMF1927
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: