Healthcare Provider Details

I. General information

NPI: 1164333795
Provider Name (Legal Business Name): THOUSAND BRANCHES PROFESSIONALS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21802 BURBANK BLVD STE 202
WOODLAND HILLS CA
91367
US

IV. Provider business mailing address

21802 BURBANK BLVD STE 202
WOODLAND HILLS CA
91367
US

V. Phone/Fax

Practice location:
  • Phone: 818-405-8014
  • Fax:
Mailing address:
  • Phone: 818-405-8014
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: STEVE FILTON
Title or Position: VICE PRESIDENT
Credential:
Phone: 610-382-3319