Healthcare Provider Details

I. General information

NPI: 1023231313
Provider Name (Legal Business Name): DANA ANN WYSS MFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2007
Last Update Date: 02/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4025 W 226TH ST
TORRANCE CA
90505-2340
US

IV. Provider business mailing address

4025 W 226TH ST
TORRANCE CA
90505-2340
US

V. Phone/Fax

Practice location:
  • Phone: 213-841-0799
  • Fax:
Mailing address:
  • Phone: 213-841-0799
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC48355
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: