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General NPI Number Information
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NPI Number | 1871086983
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Entity Type | Organization
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Legal Business Name | HOLLYWOOD FAMILY THERAPY, INC
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Dates
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Enumeration Date | 06/13/2018
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Last Update Date | 06/13/2018
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Provider Practice Location Address
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Address Line | 3111 LOS FELIZ BLVD STE 106
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City | LOS ANGELES
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State | CA
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Zip | 90039-1599
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Country | US
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Telephone | 323-741-0044
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Fax |
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Provider Business Mailing Address
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Address Line | 3111 LOS FELIZ BLVD STE 106
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City | LOS ANGELES
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State | CA
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Zip | 90039-1599
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Country | US
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Telephone | 323-741-0044
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MS. SHANNON LEE
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Credential | LMFT
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Telephone | 323-741-0044
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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 | 47482
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License Number State | CA
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