Healthcare Provider Details

I. General information

NPI: 1295548659
Provider Name (Legal Business Name): AVALON PATH MARRIAGE, COUPLE, AND INDIVIDUAL THERAPY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2025
Last Update Date: 02/06/2025
Certification Date: 02/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

127 THAMES ST.
THOUSAND OAKS CA
91360
US

IV. Provider business mailing address

5737 KANAN RD # 819
AGOURA HILLS CA
91301-1601
US

V. Phone/Fax

Practice location:
  • Phone: 818-975-0130
  • Fax:
Mailing address:
  • Phone: 818-975-0130
  • 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: LORA HNAT
Title or Position: PRESIDENT/DIRECTOR
Credential: LMFT
Phone: 818-975-0130