=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811367758
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WENDY CRANDALL-COHEN, M.A. LMFT
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/05/2015
-----------------------------------------------------
Last Update Date | 10/05/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 28720 CANWOOD ST SUITE 204
-----------------------------------------------------
City | AGOURA HILLS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91301-4521
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-307-1514
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 28720 CANWOOD ST SUITE 204
-----------------------------------------------------
City | AGOURA HILLS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91301-4521
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-307-1514
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PSYCHOTHERAPIST
-----------------------------------------------------
Name | MRS. WENDY MARIE CRANDALL-COHEN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 818-307-1514
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | LMFT41754
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------