Provider Demographics
NPI:1689880882
Name:VAN ZANDT, VICTORIA LOUISE (LMFT)
Entity Type:Individual
Prefix:MS
First Name:VICTORIA
Middle Name:LOUISE
Last Name:VAN ZANDT
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 1:12304 SANTA MONICA BLVD
Mailing Address - Street 2:SUITE 327
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-2551
Mailing Address - Country:US
Mailing Address - Phone:310-922-3957
Mailing Address - Fax:310-423-0114
Practice Address - Street 1:12304 SANTA MONICA BLVD
Practice Address - Street 2:SUITE 327
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-2551
Practice Address - Country:US
Practice Address - Phone:310-922-3957
Practice Address - Fax:310-423-0114
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2014-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50513106H00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program