Provider Demographics
NPI:1437678497
Name:SIDHU, PRABHJOT
Entity Type:Individual
Prefix:
First Name:PRABHJOT
Middle Name:
Last Name:SIDHU
Suffix:
Gender:F
Credentials:
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 222
Mailing Address - Street 2:
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91603-0222
Mailing Address - Country:US
Mailing Address - Phone:213-326-3925
Mailing Address - Fax:
Practice Address - Street 1:27200 TOURNEY RD STE 175
Practice Address - Street 2:
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91355-4990
Practice Address - Country:US
Practice Address - Phone:661-705-4670
Practice Address - Fax:661-964-3273
Is Sole Proprietor?:No
Enumeration Date:2017-09-11
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAMFT109262106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist