Provider Demographics
NPI:1467666941
Name:LENNON, ATHENA UBACH (MFT)
Entity Type:Individual
Prefix:MRS
First Name:ATHENA
Middle Name:UBACH
Last Name:LENNON
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8235 SANTA MONICA BLVD
Mailing Address - Street 2:SUITE 311
Mailing Address - City:WEST HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90046-5914
Mailing Address - Country:US
Mailing Address - Phone:323-957-4739
Mailing Address - Fax:
Practice Address - Street 1:8235 SANTA MONICA BLVD
Practice Address - Street 2:SUITE 311
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90046-5914
Practice Address - Country:US
Practice Address - Phone:323-957-4739
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC41095106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist