Healthcare Provider Details

I. General information

NPI: 1174729222
Provider Name (Legal Business Name): PEPPERDINE COMMUNITY COUNSELING CENTER ENCINO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2007
Last Update Date: 07/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16830 VENTURA BLVD #216
ENCINO CA
91436-1707
US

IV. Provider business mailing address

16830 VENTURA BLVD #216
ENCINO CA
91436-1707
US

V. Phone/Fax

Practice location:
  • Phone: 818-501-1678
  • Fax:
Mailing address:
  • Phone: 818-501-1678
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. ANAT COHEN
Title or Position: DIRECTOR
Credential: PH.D.
Phone: 818-501-1660