Healthcare Provider Details

I. General information

NPI: 1699806901
Provider Name (Legal Business Name): JUDY ELLEN MEZA LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 10/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6305 WOODMAN AVE
VAN NUYS CA
91401-2346
US

IV. Provider business mailing address

PO BOX 221162
NEWHALL CA
91322-1162
US

V. Phone/Fax

Practice location:
  • Phone: 818-909-3382
  • Fax:
Mailing address:
  • Phone: 661-253-1534
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFT33294
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: