Provider Demographics
NPI:1346530789
Name:LOEB, CHRISTINE G (LMFT, RD)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:G
Last Name:LOEB
Suffix:
Gender:F
Credentials:LMFT, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16055 VENTURA BLVD
Mailing Address - Street 2:STE 920
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-2601
Mailing Address - Country:US
Mailing Address - Phone:818-501-0730
Mailing Address - Fax:818-907-8161
Practice Address - Street 1:16055 VENTURA BLVD
Practice Address - Street 2:STE 920
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-2601
Practice Address - Country:US
Practice Address - Phone:818-501-0730
Practice Address - Fax:818-907-8831
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-18
Last Update Date:2014-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT28567106H00000X
133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered