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General NPI Number Information
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NPI Number | 1467220988
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Entity Type | Individual
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Provider Name | JACOB WILEN AMFT
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Gender | Male
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Dates
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Enumeration Date | 12/14/2023
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Last Update Date | 12/03/2024
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Provider Practice Location Address
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Address Line | 651 N SEPULVEDA BLVD # 2019
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City | LOS ANGELES
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State | CA
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Zip | 90049-2185
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Country | US
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Telephone | 323-542-8255
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Fax |
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Provider Business Mailing Address
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Address Line | 651 N SEPULVEDA BLVD # 2019
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City | LOS ANGELES
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State | CA
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Zip | 90049-2185
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Country | US
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Telephone | 323-542-8255
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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 | 141949
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License Number State | CA
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