Healthcare Provider Details

I. General information

NPI: 1619392107
Provider Name (Legal Business Name): SETH FENTON LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/20/2014
Last Update Date: 03/04/2026
Certification Date: 03/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

265 GREEN HEATH PL
THOUSAND OAKS CA
91361-1118
US

IV. Provider business mailing address

265 GREEN HEATH PL
THOUSAND OAKS CA
91361-1118
US

V. Phone/Fax

Practice location:
  • Phone: 818-205-7384
  • Fax:
Mailing address:
  • Phone: 818-205-7384
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number78445
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: