Provider Demographics
NPI:1679015135
Name:FRESCHL, MARIE LALLANA (LMFT)
Entity Type:Individual
Prefix:MS
First Name:MARIE
Middle Name:LALLANA
Last Name:FRESCHL
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 1:734 SILVER SPUR RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:ROLLING HILLS ESTATES
Mailing Address - State:CA
Mailing Address - Zip Code:90274-3631
Mailing Address - Country:US
Mailing Address - Phone:424-625-5714
Mailing Address - Fax:
Practice Address - Street 1:734 SILVER SPUR RD
Practice Address - Street 2:SUITE 202
Practice Address - City:ROLLING HILLS ESTATES
Practice Address - State:CA
Practice Address - Zip Code:90274-3631
Practice Address - Country:US
Practice Address - Phone:424-625-5714
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-15
Last Update Date:2016-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA96413106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist