Provider Demographics
NPI:1114183522
Name:ROY, LIA (LMFT)
Entity Type:Individual
Prefix:MS
First Name:LIA
Middle Name:
Last Name:ROY
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23480 PARK SORRENTO
Mailing Address - Street 2:SUITE 115A
Mailing Address - City:CALABASAS
Mailing Address - State:CA
Mailing Address - Zip Code:91302
Mailing Address - Country:US
Mailing Address - Phone:818-515-4576
Mailing Address - Fax:
Practice Address - Street 1:23480 PARK SORRENTO
Practice Address - Street 2:SUITE 115A
Practice Address - City:CALABASAS
Practice Address - State:CA
Practice Address - Zip Code:91302-1306
Practice Address - Country:US
Practice Address - Phone:818-515-4576
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-05
Last Update Date:2008-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA050172758101Y00000X
CA43435106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor