Healthcare Provider Details

I. General information

NPI: 1609602317
Provider Name (Legal Business Name): LIZETTE PAVON LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2024
Last Update Date: 10/18/2024
Certification Date: 10/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8335 WINNETKA AVE # 224
WINNETKA CA
91306-1630
US

IV. Provider business mailing address

PO BOX 950074
MISSION HILLS CA
91395-0074
US

V. Phone/Fax

Practice location:
  • Phone: 818-493-9137
  • Fax:
Mailing address:
  • Phone: 818-268-2173
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number132237
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: