Provider Demographics
NPI:1386026250
Name:ADELINA MEHRAZARIN BRISBOIS LMFT
Entity Type:Organization
Organization Name:ADELINA MEHRAZARIN BRISBOIS LMFT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MARRIAGE AND FAMILY THERPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:ADELINA
Authorized Official - Middle Name:MEHRAZARIN
Authorized Official - Last Name:BRISBOIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:213-290-5412
Mailing Address - Street 1:4607 LAKEVIEW CANYON RD # 407
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91361-4028
Mailing Address - Country:US
Mailing Address - Phone:213-290-5412
Mailing Address - Fax:
Practice Address - Street 1:18757 BURBANK BLVD STE 125
Practice Address - Street 2:
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-3345
Practice Address - Country:US
Practice Address - Phone:213-290-5412
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-26
Last Update Date:2015-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52767106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty