Healthcare Provider Details

I. General information

NPI: 1285803676
Provider Name (Legal Business Name): VALORIE ZAGELBAUM MFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/29/2008
Last Update Date: 02/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 S FAIRFAX AVE STE 214
LOS ANGELES CA
90036-3198
US

IV. Provider business mailing address

15336 DEVONSHIRE ST UNIT 6
MISSION HILLS CA
91345-2755
US

V. Phone/Fax

Practice location:
  • Phone: 323-538-0975
  • Fax:
Mailing address:
  • Phone: 323-538-0975
  • Fax: 818-484-4084

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License NumberMFC27615
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: