Healthcare Provider Details

I. General information

NPI: 1619267143
Provider Name (Legal Business Name): BEHAVIOR THERAPY AND FAMILY COUNSELING CLINIC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2011
Last Update Date: 04/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31416 AGOURA RD SUITE 245
WESTLAKE VILLAGE CA
91361-4621
US

IV. Provider business mailing address

31416 AGOURA RD SUITE 245
WESTLAKE VILLAGE CA
91361-4621
US

V. Phone/Fax

Practice location:
  • Phone: 818-706-9913
  • Fax: 805-491-8272
Mailing address:
  • Phone: 818-706-9913
  • Fax: 805-491-8272

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY10035
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC21169
License Number StateCA

VIII. Authorized Official

Name: MARY B. BARMANN
Title or Position: OWNER
Credential: MFT
Phone: 818-706-9913