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General NPI Number Information
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NPI Number | 1780776971
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Entity Type | Individual
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Provider Name | BERTHA HELEN HEAD M.A. LMFT
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Gender | Female
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Dates
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Enumeration Date | 09/28/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 850 COLORADO BLVD SUITE 102
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City | LOS ANGELES
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State | CA
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Zip | 90041-1738
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Country | US
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Telephone | 332-325-4608
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Fax | 818-790-5064
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Provider Business Mailing Address
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Address Line | 5123 JARVIS AVE
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City | LA CANADA
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State | CA
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Zip | 91011-1642
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Country | US
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Telephone | 818-790-2290
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Fax | 818-790-5064
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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 | MFC39297
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License Number State | CA
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