Healthcare Provider Details

I. General information

NPI: 1982182853
Provider Name (Legal Business Name): DANETTE BALEN-GARCIA M.A., LMFT (#24798)
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2018
Last Update Date: 08/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

367 E THOUSAND OAKS BLVD
THOUSAND OAKS CA
91360-8253
US

IV. Provider business mailing address

6610 MELBA AVE
WEST HILLS CA
91307-3409
US

V. Phone/Fax

Practice location:
  • Phone: 818-519-0716
  • Fax:
Mailing address:
  • Phone: 818-519-0716
  • Fax:

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:
Title or Position:
Credential:
Phone: