Healthcare Provider Details

I. General information

NPI: 1427905777
Provider Name (Legal Business Name): CANOPY COLLABORATIVE PROFESSIONAL CLINICAL COUNSELOR, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2026
Last Update Date: 03/16/2026
Certification Date: 03/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4370 TUJUNGA AVE STE 210
STUDIO CITY CA
91604-2763
US

IV. Provider business mailing address

4370 TUJUNGA AVE STE 210
STUDIO CITY CA
91604-2763
US

V. Phone/Fax

Practice location:
  • Phone: 424-231-4450
  • Fax:
Mailing address:
  • Phone: 424-231-4450
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: CORBETT HANCOCK MILLER
Title or Position: OWNER/SECRETARY
Credential: LCSW
Phone: 213-880-5428