Provider Demographics
NPI:1376942276
Name:MARVIN JAY FIBUS, PH.D. FAMILY COUNSELING INC.
Entity Type:Organization
Organization Name:MARVIN JAY FIBUS, PH.D. FAMILY COUNSELING INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARVIN
Authorized Official - Middle Name:JAY
Authorized Official - Last Name:FIBUS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:818-395-2831
Mailing Address - Street 1:11945 ADDISON ST
Mailing Address - Street 2:
Mailing Address - City:VALLEY VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91607-3106
Mailing Address - Country:US
Mailing Address - Phone:818-325-6766
Mailing Address - Fax:818-760-8112
Practice Address - Street 1:13949 VENTURA BLVD
Practice Address - Street 2:SUITE 210
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91423-3584
Practice Address - Country:US
Practice Address - Phone:818-395-2831
Practice Address - Fax:818-760-8112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-15
Last Update Date:2014-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC16267106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty