Healthcare Provider Details

I. General information

NPI: 1003839341
Provider Name (Legal Business Name): MARSHA M. LEWIS M.F.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11712 MOORPARK ST SUITE # 206
STUDIO CITY CA
91604-2154
US

IV. Provider business mailing address

11712 MOORPARK ST SUITE # 206
STUDIO CITY CA
91604-2154
US

V. Phone/Fax

Practice location:
  • Phone: 818-771-6419
  • Fax: 310-659-4490
Mailing address:
  • Phone: 818-771-6419
  • Fax: 310-659-4490

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number32421
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: