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General NPI Number Information
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NPI Number | 1811472996
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Entity Type | Organization
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Legal Business Name | ERIKA DAHLE PETRAS MARRIAGE AND FAMILY THERAPY A PROFESSIONAL CORP
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Dates
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Enumeration Date | 09/25/2018
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Last Update Date | 09/25/2018
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Provider Practice Location Address
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Address Line | 520 S SEPULVEDA BLVD STE 409
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City | LOS ANGELES
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State | CA
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Zip | 90049-3547
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Country | US
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Telephone | 818-817-1871
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Fax |
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Provider Business Mailing Address
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Address Line | 100 E THOUSAND OAKS BLVD STE 234
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City | THOUSAND OAKS
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State | CA
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Zip | 91360-8156
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Country | US
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Telephone | 818-817-1871
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. ERIKA DAHLE PETRAS
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Credential | LMFT
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Telephone | 818-817-1871
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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 |
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License Number State |
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