Provider Demographics
NPI:1629191366
Name:WESTERVELT, LANI G (MFT)
Entity Type:Individual
Prefix:MRS
First Name:LANI
Middle Name:G
Last Name:WESTERVELT
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 1:17755 E COLLIER RD
Mailing Address - Street 2:
Mailing Address - City:ACAMPO
Mailing Address - State:CA
Mailing Address - Zip Code:95220-9735
Mailing Address - Country:US
Mailing Address - Phone:209-759-3075
Mailing Address - Fax:
Practice Address - Street 1:19 E 6TH ST
Practice Address - Street 2:
Practice Address - City:TRACY
Practice Address - State:CA
Practice Address - Zip Code:95376-4107
Practice Address - Country:US
Practice Address - Phone:209-835-8583
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA38654106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist