MEDICARE: ERIKA DAHLE PETRAS MARRIAGE AND FAMILY THERAPY A PROFESSIONAL CORP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist

General Provider Information

NPI Number	:	1811472996
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ERIKA DAHLE PETRAS MARRIAGE AND FAMILY THERAPY A PROFESSIONAL CORP

Provider Business Mailing Address
First Line	:	100 E THOUSAND OAKS BLVD STE 234
Second Line	:
City	:	THOUSAND OAKS
State	:	CA
Zip	:	91360-8156
Country	:	US
Telephone Number	:	818-817-1871
Fax Number	:

Provider Business Practice Location Address
First Line	:	520 S SEPULVEDA BLVD STE 409
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90049-3547
Country	:	US
Telephone Number	:	818-817-1871
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MS. ERIKA DAHLE PETRAS
Credential	:	LMFT
Telephone Number	:	818-817-1871

Provider Enumeration Date	:	09/25/2018
Last Update Date	:	09/25/2018

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