Healthcare Provider Details

I. General information

NPI: 1407778913
Provider Name (Legal Business Name): EMOTIVE MARRIAGE AND FAMILY THERAPY PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6704 COWBOY ST
SIMI VALLEY CA
93063-5814
US

IV. Provider business mailing address

6704 COWBOY ST
SIMI VALLEY CA
93063-5814
US

V. Phone/Fax

Practice location:
  • Phone: 818-451-9696
  • Fax: 818-451-9696
Mailing address:
  • Phone: 818-451-9696
  • Fax: 818-451-9696

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DANIELLE KRISTINE WALKER
Title or Position: PRESIDENT, OWNER
Credential: LMFT
Phone: 818-451-9696