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General NPI Number Information
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NPI Number | 1669647392
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Entity Type | Individual
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Provider Name | ANGELIQUE GETTLE L.M.F.T.
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Gender | Female
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Dates
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Enumeration Date | 04/23/2008
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Last Update Date | 09/25/2024
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Provider Practice Location Address
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Address Line | 1419 STANFORD ST
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City | SANTA MONICA
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State | CA
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Zip | 90404-3145
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Country | US
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Telephone | 310-740-1313
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Fax |
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Provider Business Mailing Address
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Address Line | 1419 STANFORD ST APT A
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City | SANTA MONICA
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State | CA
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Zip | 90404-3145
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Country | US
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Telephone | 310-740-1313
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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 | 0106701
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 47880
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License Number State | CA
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