Provider Demographics
NPI:1093826273
Name:VAL-ESSEN, ILENE (MFT PHD)
Entity Type:Individual
Prefix:
First Name:ILENE
Middle Name:
Last Name:VAL-ESSEN
Suffix:
Gender:F
Credentials:MFT PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4909 ST LOUIS COURT
Mailing Address - Street 2:
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90230-4317
Mailing Address - Country:US
Mailing Address - Phone:310-839-1571
Mailing Address - Fax:310-839-1614
Practice Address - Street 1:4909 ST LOUIS COURT
Practice Address - Street 2:
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90230-4317
Practice Address - Country:US
Practice Address - Phone:310-839-1571
Practice Address - Fax:310-839-1614
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT6843106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist