Healthcare Provider Details

I. General information

NPI: 1225163504
Provider Name (Legal Business Name): LANAE FACIANE MFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2007
Last Update Date: 02/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5740 RALSTON ST. SUITE 100
VENTURA CA
93003-7847
US

IV. Provider business mailing address

5740 RALSTON ST. SUITE 100
VENTURA CA
93003-7847
US

V. Phone/Fax

Practice location:
  • Phone: 805-654-5570
  • Fax: 805-648-9662
Mailing address:
  • Phone: 805-654-5570
  • Fax: 805-648-9662

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number48761
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: