Provider Demographics
NPI:1376710855
Name:ALLISON, MARK (LMFT)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:
Last Name:ALLISON
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:MARK
Other - Middle Name:ADAMS
Other - Last Name:ALLISON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS, MFT
Mailing Address - Street 1:822 S ROBERTSON BLVD STE 305
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90035-1632
Mailing Address - Country:US
Mailing Address - Phone:310-651-8906
Mailing Address - Fax:
Practice Address - Street 1:822 S ROBERTSON BLVD STE 305
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90035-1632
Practice Address - Country:US
Practice Address - Phone:310-651-8906
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-13
Last Update Date:2019-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49490106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist