Healthcare Provider Details

I. General information

NPI: 1326392598
Provider Name (Legal Business Name): MCGARVA THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2012
Last Update Date: 08/05/2020
Certification Date: 08/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30721 RUSSELL RANCH RD STE 140
WESTLAKE VILLAGE CA
91362-7383
US

IV. Provider business mailing address

30721 RUSSELL RANCH RD STE 140
WESTLAKE VILLAGE CA
91362-7383
US

V. Phone/Fax

Practice location:
  • Phone: 818-835-2514
  • Fax:
Mailing address:
  • Phone: 818-835-2514
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC 111
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC 96
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC 49540
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC 42154
License Number StateCA

VIII. Authorized Official

Name: DR. DAVID JUNG MCGARVA
Title or Position: PARTNER
Credential:
Phone: 818-584-6789