Provider Demographics
NPI:1114135506
Name:CONLEY, CAROLINE (MFT)
Entity Type:Individual
Prefix:
First Name:CAROLINE
Middle Name:
Last Name:CONLEY
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 1279
Mailing Address - Street 2:
Mailing Address - City:STUDIO CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91614-0279
Mailing Address - Country:US
Mailing Address - Phone:818-506-4452
Mailing Address - Fax:818-506-4472
Practice Address - Street 1:12444 VENTURA BLVD
Practice Address - Street 2:#208
Practice Address - City:STUDIO CITY
Practice Address - State:CA
Practice Address - Zip Code:91604-2409
Practice Address - Country:US
Practice Address - Phone:818-506-4452
Practice Address - Fax:818-506-4472
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC6075106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist