Healthcare Provider Details

I. General information

NPI: 1477338598
Provider Name (Legal Business Name): ALLISON CIONGOLI MFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2023
Last Update Date: 08/28/2023
Certification Date: 08/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12424 WILSHIRE BLVD STE 650
LOS ANGELES CA
90025-1081
US

IV. Provider business mailing address

24610 THOUSAND PEAKS RD
CALABASAS CA
91302-3204
US

V. Phone/Fax

Practice location:
  • Phone: 310-571-8760
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberAMFT126956
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: