Healthcare Provider Details

I. General information

NPI: 1902727308
Provider Name (Legal Business Name): MARISSA MORENO-MCCULLOUGH LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5855 TOPANGA CANYON BLVD STE 150
WOODLAND HILLS CA
91367-4685
US

IV. Provider business mailing address

440 N BARRANCA AVE # 2466
COVINA CA
91723-1722
US

V. Phone/Fax

Practice location:
  • Phone: 310-293-8085
  • Fax:
Mailing address:
  • Phone: 310-293-8085
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TP0814X
TaxonomyPsychoanalysis Psychologist
License Number160362
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: