Provider Demographics
NPI:1154659613
Name:ITULE, CARA A (MA, MFT)
Entity Type:Individual
Prefix:MRS
First Name:CARA
Middle Name:A
Last Name:ITULE
Suffix:
Gender:F
Credentials:MA, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5012 CHESEBRO RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:AGOURA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91301-2272
Mailing Address - Country:US
Mailing Address - Phone:818-324-6594
Mailing Address - Fax:
Practice Address - Street 1:5012 CHESEBRO RD
Practice Address - Street 2:STE. 201
Practice Address - City:AGOURA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91301-2272
Practice Address - Country:US
Practice Address - Phone:818-324-6594
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-20
Last Update Date:2015-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC44708106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMFC47708OtherDCA BOARD OF BEHAVIORAL SCIENCES