Provider Demographics
NPI:1215013107
Name:HARTLEY, MYRNA HARPER (MFT)
Entity Type:Individual
Prefix:
First Name:MYRNA
Middle Name:HARPER
Last Name:HARTLEY
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 1:20100 ALLENTOWN DR.
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91364
Mailing Address - Country:US
Mailing Address - Phone:818-716-9373
Mailing Address - Fax:818-716-9373
Practice Address - Street 1:20100 ALLENTOWN DR
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91364-3511
Practice Address - Country:US
Practice Address - Phone:818-716-9373
Practice Address - Fax:818-716-9373
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC15325106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist