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General NPI Number Information
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NPI Number | 1215370242
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Entity Type | Individual
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Provider Name | MAIJA ELISABETH VANCE M.A.
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Gender | Female
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Dates
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Enumeration Date | 04/09/2013
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Last Update Date | 10/04/2022
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Provider Practice Location Address
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Address Line | 1220 2ND ST
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City | SANTA MONICA
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State | CA
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Zip | 90401-1167
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Country | US
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Telephone | 626-268-0240
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Fax |
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Provider Business Mailing Address
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Address Line | 150 W SIERRA MADRE BLVD
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City | SIERRA MADRE
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State | CA
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Zip | 91024
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Country | US
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Telephone | 626-802-5490
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 121437
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License Number State | CA
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