Provider Demographics
NPI:1437499860
Name:RYBKO, ELENA (LMFT)
Entity Type:Individual
Prefix:
First Name:ELENA
Middle Name:
Last Name:RYBKO
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 941673
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93094-1673
Mailing Address - Country:US
Mailing Address - Phone:805-206-9155
Mailing Address - Fax:
Practice Address - Street 1:5655 LINDERO CANYON RD
Practice Address - Street 2:SUITE 726
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91362-4016
Practice Address - Country:US
Practice Address - Phone:805-206-9155
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-21
Last Update Date:2013-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52636106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist