Healthcare Provider Details

I. General information

NPI: 1730946443
Provider Name (Legal Business Name): JUSTIN VAHALA LMFT-LP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/29/2024
Last Update Date: 03/14/2024
Certification Date: 03/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

286 5TH AVE # 7H
NEW YORK NY
10001-4512
US

IV. Provider business mailing address

2248 BROADWAY # 1125
NEW YORK NY
10024-5805
US

V. Phone/Fax

Practice location:
  • Phone: 929-357-2212
  • Fax:
Mailing address:
  • Phone: 917-597-4886
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberP126348
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: