Healthcare Provider Details

I. General information

NPI: 1992949440
Provider Name (Legal Business Name): STEPHANIE KAVOULAKOS M.A., LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/28/2009
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4419 VAN NUYS BLVD STE 208
SHERMAN OAKS CA
91403-5715
US

IV. Provider business mailing address

4419 VAN NUYS BLVD STE 208
SHERMAN OAKS CA
91403-5715
US

V. Phone/Fax

Practice location:
  • Phone: 818-262-5990
  • Fax:
Mailing address:
  • Phone: 818-262-5990
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number77366
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: