Healthcare Provider Details

I. General information

NPI: 1396519039
Provider Name (Legal Business Name): ALLISON WEBER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ALLISON SHUCK

II. Dates (important events)

Enumeration Date: 11/13/2023
Last Update Date: 11/13/2023
Certification Date: 11/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2999 OVERLAND AVE STE 209
LOS ANGELES CA
90064-4243
US

IV. Provider business mailing address

41 E FOOTHILL BLVD STE 102
ARCADIA CA
91006-2361
US

V. Phone/Fax

Practice location:
  • Phone: 310-957-5641
  • Fax: 626-737-6034
Mailing address:
  • Phone: 626-701-4249
  • Fax: 626-737-6034

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number137010
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: