Provider Demographics
NPI:1528184280
Name:ROLLENS, LUANN (MA)
Entity Type:Individual
Prefix:MS
First Name:LUANN
Middle Name:
Last Name:ROLLENS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14520 DICKENS ST. #310
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91403
Mailing Address - Country:US
Mailing Address - Phone:818-528-7440
Mailing Address - Fax:
Practice Address - Street 1:6800 OWENSMOUTH AVE STE 310
Practice Address - Street 2:
Practice Address - City:CANOGA PARK
Practice Address - State:CA
Practice Address - Zip Code:91303-4245
Practice Address - Country:US
Practice Address - Phone:818-347-8565
Practice Address - Fax:818-347-0506
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 33013106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist