Provider Demographics
NPI:1497072938
Name:IRIAS, JOHN ANDREW (LMFT)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:ANDREW
Last Name:IRIAS
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5743 CORSA AVE
Mailing Address - Street 2:STE 112
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91362
Mailing Address - Country:US
Mailing Address - Phone:805-419-3449
Mailing Address - Fax:323-254-9087
Practice Address - Street 1:5743 CORSA AVE
Practice Address - Street 2:STE 112
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91362
Practice Address - Country:US
Practice Address - Phone:805-419-3449
Practice Address - Fax:323-254-9087
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-23
Last Update Date:2018-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT83364106H00000X
CA83364106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA174400000XOtherOTHER