Provider Demographics
NPI:1316383987
Name:WALD, RAIN ELIZABETH (LMFT)
Entity Type:Individual
Prefix:
First Name:RAIN
Middle Name:ELIZABETH
Last Name:WALD
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10315 WOODLEY AVE STE 122
Mailing Address - Street 2:
Mailing Address - City:GRANADA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91344-6953
Mailing Address - Country:US
Mailing Address - Phone:818-389-0928
Mailing Address - Fax:
Practice Address - Street 1:10315 WOODLEY AVE STE 122
Practice Address - Street 2:
Practice Address - City:GRANADA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91344-6953
Practice Address - Country:US
Practice Address - Phone:818-389-0928
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-22
Last Update Date:2014-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC53038106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist