Provider Demographics
NPI:1336487958
Name:DILLON TSCHUDI, MARY SUSAN (LMFT)
Entity Type:Individual
Prefix:
First Name:MARY SUSAN
Middle Name:
Last Name:DILLON TSCHUDI
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 1:4333 PARK TERRACE DRIVE
Mailing Address - Street 2:SUITE 150
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91361-5652
Mailing Address - Country:US
Mailing Address - Phone:805-557-0405
Mailing Address - Fax:818-991-2060
Practice Address - Street 1:4333 PARK TERRACE DR
Practice Address - Street 2:SUITE 150
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91361-4642
Practice Address - Country:US
Practice Address - Phone:805-557-0405
Practice Address - Fax:818-991-2060
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-17
Last Update Date:2013-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA38762106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist