Healthcare Provider Details

I. General information

NPI: 1376379826
Provider Name (Legal Business Name): ENHANCED MINDFULNESS MARRIAGE & FAMILY THERAPY, APC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2024
Last Update Date: 06/28/2025
Certification Date: 06/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30941 AGOURA RD STE 210
WESTLAKE VILLAGE CA
91361-4658
US

IV. Provider business mailing address

PO BOX 5753
OXNARD CA
93031-5753
US

V. Phone/Fax

Practice location:
  • Phone: 805-272-0077
  • Fax: 747-222-7107
Mailing address:
  • Phone: 805-272-0077
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. JONATHAN BILAL ABDULLAH
Title or Position: CEO
Credential: ED.D
Phone: 805-272-0077