Provider Demographics
NPI:1093930703
Name:JASKOL, ANITA MILLICENT (PHD, MFT)
Entity Type:Individual
Prefix:DR
First Name:ANITA
Middle Name:MILLICENT
Last Name:JASKOL
Suffix:
Gender:F
Credentials:PHD, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4316 RAINTREE CIR
Mailing Address - Street 2:
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90230-4475
Mailing Address - Country:US
Mailing Address - Phone:310-838-1937
Mailing Address - Fax:
Practice Address - Street 1:4316 RAINTREE CIR
Practice Address - Street 2:
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90230-4475
Practice Address - Country:US
Practice Address - Phone:310-838-1937
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT 14005106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist