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General NPI Number Information
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NPI Number | 1134423858
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Entity Type | Organization
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Legal Business Name | CLINIC FOR ASSESSMENTS AND NEEDS OF DEVELOPMENTALLY DELAYED INDIVIDUAL
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Dates
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Enumeration Date | 01/10/2011
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Last Update Date | 12/17/2025
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Provider Practice Location Address
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Address Line | 16055 VENTURA BLVD SUITE 605
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City | ENCINO
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State | CA
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Zip | 91436
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Country | US
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Telephone | 818-233-0058
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Fax |
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Provider Business Mailing Address
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Address Line | 16055 VENTURA BLVD SUITE 605
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City | ENCINO
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State | CA
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Zip | 91436
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Country | US
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Telephone | 818-233-0058
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CURT WIDHALM
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Credential |
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Telephone | 818-233-0058
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MFC 47315
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License Number State | CA
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