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General NPI Number Information
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NPI Number | 1356991137
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Entity Type | Organization
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Legal Business Name | HOLLYWOOD FAMILY THERAPY GROUP, INC
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Dates
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Enumeration Date | 09/13/2019
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Last Update Date | 05/13/2020
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Provider Practice Location Address
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Address Line | 3111 LOS FELIZ BLVD STE 106
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City | LOS ANGELES
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State | CA
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Zip | 90039-1599
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Country | US
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Telephone | 323-868-6023
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Fax |
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Provider Business Mailing Address
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Address Line | 3111 LOS FELIZ BLVD STE 106
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City | LOS ANGELES
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State | CA
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Zip | 90039-1599
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Country | US
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Telephone | 323-741-0044
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Fax | 323-522-6542
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Authorized Official
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Title or Position | CEO
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Name | SHANNON LEE
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Credential | LMFT
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Telephone | 323-741-0044
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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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