Provider Demographics
NPI:1023203155
Name:URIBE, MAGGIE (MA, MFT)
Entity Type:Individual
Prefix:MS
First Name:MAGGIE
Middle Name:
Last Name:URIBE
Suffix:
Gender:F
Credentials:MA, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18401 BURBANK BLVD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-2822
Mailing Address - Country:US
Mailing Address - Phone:818-378-7845
Mailing Address - Fax:818-344-5525
Practice Address - Street 1:18401 BURBANK BLVD
Practice Address - Street 2:SUITE 203
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-2822
Practice Address - Country:US
Practice Address - Phone:818-378-7845
Practice Address - Fax:818-344-5525
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-11
Last Update Date:2007-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 40915106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist