=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801772868
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COR COUNSELING MARRIAGE AND FAMILY THERAPIST
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/14/2025
-----------------------------------------------------
Last Update Date | 08/14/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5723 STAR LN
-----------------------------------------------------
City | WOODLAND HILLS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91367-3961
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-272-6821
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5723 STAR LN
-----------------------------------------------------
City | WOODLAND HILLS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91367-3961
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-272-6821
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | NICOLE ANAVIM
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 310-272-6821
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0801X
-----------------------------------------------------
Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------