Healthcare Provider Details

I. General information

NPI: 1174985782
Provider Name (Legal Business Name): VANESSA VILLA LMFT #158703
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2016
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2513 SICHEL ST
LOS ANGELES CA
90031-2317
US

IV. Provider business mailing address

2513 SICHEL ST
LOS ANGELES CA
90031-2317
US

V. Phone/Fax

Practice location:
  • Phone: 213-446-6229
  • Fax: 213-446-6229
Mailing address:
  • Phone: 213-446-6229
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number158703
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: