Provider Demographics
NPI:1215588983
Name:JEBREEL, DANA TAL (PSYD)
Entity Type:Individual
Prefix:DR
First Name:DANA
Middle Name:TAL
Last Name:JEBREEL
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5214 YOLANDA AVE
Mailing Address - Street 2:
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-4015
Mailing Address - Country:US
Mailing Address - Phone:310-500-9610
Mailing Address - Fax:
Practice Address - Street 1:450 N BEDFORD DR STE 204
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-4306
Practice Address - Country:US
Practice Address - Phone:310-598-3898
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-24
Last Update Date:2019-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31161103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical