Healthcare Provider Details

I. General information

NPI: 1790639789
Provider Name (Legal Business Name): THERAPY CLUBHOUSE, A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/25/2026
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2535 TOWNSGATE RD STE 110
WESTLAKE VILLAGE CA
91361-5971
US

IV. Provider business mailing address

2535 TOWNSGATE RD STE 110
WESTLAKE VILLAGE CA
91361-5971
US

V. Phone/Fax

Practice location:
  • Phone: 818-625-9248
  • Fax:
Mailing address:
  • Phone: 818-625-9248
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: RACHEL YASHOUAFAR
Title or Position: CEO
Credential:
Phone: 818-625-9248