Provider Demographics
NPI:1255689519
Name:BIRDSONG, VANESSA LEIGH (MS, LMFT #77990)
Entity Type:Individual
Prefix:MRS
First Name:VANESSA
Middle Name:LEIGH
Last Name:BIRDSONG
Suffix:
Gender:F
Credentials:MS, LMFT #77990
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24414 MCBEAN PKWY APT 228
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARITA
Mailing Address - State:CA
Mailing Address - Zip Code:91355-1970
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:23236 LYONS AVE STE 212
Practice Address - Street 2:
Practice Address - City:SANTA CLARITA
Practice Address - State:CA
Practice Address - Zip Code:91321-5014
Practice Address - Country:US
Practice Address - Phone:661-513-4294
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-16
Last Update Date:2019-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA77990106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist