Provider Demographics
NPI:1710685565
Name:RIGNACK, ILISE ANN (AMFT)
Entity Type:Individual
Prefix:
First Name:ILISE
Middle Name:ANN
Last Name:RIGNACK
Suffix:
Gender:F
Credentials:AMFT
Other - Prefix:
Other - First Name:ILISE
Other - Middle Name:ANN
Other - Last Name:KAPEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:2488 RUTLAND PL
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91362-1600
Mailing Address - Country:US
Mailing Address - Phone:310-367-5872
Mailing Address - Fax:
Practice Address - Street 1:1911 WILLIAMS DR STE 150
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93036-2612
Practice Address - Country:US
Practice Address - Phone:805-981-8460
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-21
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA137491106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist