Provider Demographics
NPI:1417209065
Name:KATZ, MARLA (MFT I)
Entity Type:Individual
Prefix:MS
First Name:MARLA
Middle Name:
Last Name:KATZ
Suffix:
Gender:F
Credentials:MFT I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11693 SAN VICENTE BLVD
Mailing Address - Street 2:#464
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90049-5105
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:280 S LOS ROBLES AVE
Practice Address - Street 2:SUITE D
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-2872
Practice Address - Country:US
Practice Address - Phone:818-259-9086
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-05
Last Update Date:2012-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF70437106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist