Provider Demographics
NPI:1578924536
Name:SHOMOF, JANE (LMFT)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:
Last Name:SHOMOF
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 1:724 S SPRING ST #1102
Mailing Address - Street 2:ELEMENTS THERAPY
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90014
Mailing Address - Country:US
Mailing Address - Phone:818-457-6305
Mailing Address - Fax:
Practice Address - Street 1:724 S SPRING ST #1102
Practice Address - Street 2:ELEMENTS THERAPY
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90014
Practice Address - Country:US
Practice Address - Phone:818-457-6305
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-17
Last Update Date:2016-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT86590106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist