Provider Demographics
NPI:1164440202
Name:PALIK, ANN L (MFT)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:L
Last Name:PALIK
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 6668
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90504-0668
Mailing Address - Country:US
Mailing Address - Phone:310-840-2341
Mailing Address - Fax:
Practice Address - Street 1:3820 DEL AMO BLVD
Practice Address - Street 2:SUITE 208
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-2150
Practice Address - Country:US
Practice Address - Phone:310-840-2341
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33337106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist