Healthcare Provider Details

I. General information

NPI: 1194030148
Provider Name (Legal Business Name): ALLYSON BROOKE MONCADA LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALLYSON BROOKE BUICE

II. Dates (important events)

Enumeration Date: 08/14/2010
Last Update Date: 01/17/2020
Certification Date: 01/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1227 E LOS ANGELES AVE
SIMI VALLEY CA
93065-2871
US

IV. Provider business mailing address

9400 CORBIN AVE APT 1012
NORTHRIDGE CA
91324-2524
US

V. Phone/Fax

Practice location:
  • Phone: 805-582-4080
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberIMF 68099
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number91044
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: