Provider Demographics
NPI:1003950791
Name:WIDHALM, CURT RYAN (LMFT)
Entity Type:Individual
Prefix:
First Name:CURT
Middle Name:RYAN
Last Name:WIDHALM
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16055 VENTURA BLVD STE 605
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-2609
Mailing Address - Country:US
Mailing Address - Phone:818-826-3557
Mailing Address - Fax:
Practice Address - Street 1:16055 VENTURA BLVD STE 605
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-2609
Practice Address - Country:US
Practice Address - Phone:818-826-3557
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-16
Last Update Date:2021-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 47333106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist