Provider Demographics
NPI:1043861578
Name:MAZZOLA, COURTNEY (MFT)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:
Last Name:MAZZOLA
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4854
Mailing Address - Street 2:
Mailing Address - City:CHATSWORTH
Mailing Address - State:CA
Mailing Address - Zip Code:91313-4854
Mailing Address - Country:US
Mailing Address - Phone:818-590-1353
Mailing Address - Fax:
Practice Address - Street 1:948 EMBARCADERO DEL NORTE
Practice Address - Street 2:
Practice Address - City:GOLETA
Practice Address - State:CA
Practice Address - Zip Code:93117-5106
Practice Address - Country:US
Practice Address - Phone:805-699-6668
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-25
Last Update Date:2019-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA91290106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty