Healthcare Provider Details

I. General information

NPI: 1699623512
Provider Name (Legal Business Name): EB MARRIAGE AND FAMILY THERAPY PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2026
Last Update Date: 03/17/2026
Certification Date: 03/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4705 LAUREL CANYON BLVD STE 306
VALLEY VILLAGE CA
91607-5940
US

IV. Provider business mailing address

4705 LAUREL CANYON BLVD STE 306
VALLEY VILLAGE CA
91607-5940
US

V. Phone/Fax

Practice location:
  • Phone: 213-516-2480
  • Fax:
Mailing address:
  • Phone: 213-516-2480
  • 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: EMANUELA BUCHALTER
Title or Position: PRESIDENT
Credential: LMFT
Phone: 213-516-2480