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General NPI Number Information
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NPI Number | 1831753409
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Entity Type | Organization
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Legal Business Name | SANDRA P BRAVO PSYCHOTHERAPY INC
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Dates
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Enumeration Date | 04/29/2019
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Last Update Date | 04/29/2019
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Provider Practice Location Address
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Address Line | 4405 W RIVERSIDE DR STE 205
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City | BURBANK
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State | CA
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Zip | 91505-4050
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Country | US
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Telephone | 818-854-0735
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Fax |
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Provider Business Mailing Address
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Address Line | 208 S LOUISE ST
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City | GLENDALE
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State | CA
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Zip | 91205-1637
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Country | US
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Telephone | 818-854-0735
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | SANDRA PIKER BRAVO
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Credential | LMFT
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Telephone | 818-926-4032
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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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