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General NPI Number Information
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NPI Number | 1144184680
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Entity Type | Organization
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Legal Business Name | HEADWATER MARRAIGE AND FAMILY THERAPY, INC.
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Dates
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Enumeration Date | 12/10/2025
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Last Update Date | 12/10/2025
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Provider Practice Location Address
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Address Line | 1800 BRIDGEGATE ST STE 108
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City | WESTLAKE VILLAGE
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State | CA
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Zip | 91361-1468
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Country | US
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Telephone | 805-405-6299
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Fax |
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Provider Business Mailing Address
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Address Line | 1800 BRIDGEGATE ST STE 108
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City | WESTLAKE VILLAGE
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State | CA
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Zip | 91361-1468
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Country | US
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Telephone | 805-405-6299
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Fax |
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Authorized Official
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Title or Position | PRESIDENT, LEAD CLINICIAN
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Name | LANCE HOMER RACHELS
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Credential | LMFT
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Telephone | 805-405-6299
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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 |
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License Number State |
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