Provider Demographics
NPI:1609427640
Name:LA CANADA FAMILY THERAPY
Entity Type:Organization
Organization Name:LA CANADA FAMILY THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER/DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:STEPHENIE
Authorized Official - Middle Name:H
Authorized Official - Last Name:LIEVENSE
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:626-319-5477
Mailing Address - Street 1:1150 FOOTHILL BLVD STE L
Mailing Address - Street 2:
Mailing Address - City:LA CANADA FLINTRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91011-3271
Mailing Address - Country:US
Mailing Address - Phone:626-319-5477
Mailing Address - Fax:
Practice Address - Street 1:1150 FOOTHILL BLVD STE L
Practice Address - Street 2:
Practice Address - City:LA CANADA FLINTRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91011-3271
Practice Address - Country:US
Practice Address - Phone:626-319-5477
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-20
Last Update Date:2019-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty