Healthcare Provider Details

I. General information

NPI: 1255548962
Provider Name (Legal Business Name): ADELE HOUSE MFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 12/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12400 VENTURA BLVD
STUDIO CITY CA
91604-2406
US

IV. Provider business mailing address

12400 VENTURA BLVD #114
STUDIO CITY CA
91604-2406
US

V. Phone/Fax

Practice location:
  • Phone: 310-266-7462
  • Fax:
Mailing address:
  • Phone: 310-266-7462
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number46858
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: