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General NPI Number Information
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NPI Number | 1790826337
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Entity Type | Individual
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Provider Name | ROBERT EARL FIESE LMFT
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Gender | Male
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Dates
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Enumeration Date | 02/08/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 238 S RAMPART BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90057-1404
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Country | US
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Telephone | 213-639-2572
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Fax | 213-487-3769
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Provider Business Mailing Address
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Address Line | 4248 COLBATH AVE
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City | SHERMAN OAKS
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State | CA
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Zip | 91423-4210
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Country | US
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Telephone | 818-784-5695
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Fax | 213-487-3769
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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 | 28395
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License Number State | CA
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