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General NPI Number Information
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NPI Number | 1417371246
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Entity Type | Organization
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Legal Business Name | CONEJO VALLEY FAMILY COUNSELING
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Dates
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Enumeration Date | 02/14/2014
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Last Update Date | 05/09/2016
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Provider Practice Location Address
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Address Line | 1000 BUSINESS CENTER CIRCLE SUITE 104
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City | NEWBURY PARK
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State | CA
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Zip | 91320
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Country | US
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Telephone | 805-242-3120
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Fax | 720-545-9970
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Provider Business Mailing Address
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Address Line | 105 DONALD AVENUE
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City | NEWBURY PARK
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State | CA
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Zip | 91320
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Country | US
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Telephone | 805-242-3120
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Fax | 720-545-9970
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Authorized Official
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Title or Position | OWNER
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Name | MRS. JENNIFER KARA ANDERSON
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Credential | M.S.
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Telephone | 805-242-3120
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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 | 46111
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License Number State | CA
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