Provider Demographics
NPI:1841742426
Name:PARIS, EILEEN (PHD)
Entity Type:Individual
Prefix:DR
First Name:EILEEN
Middle Name:
Last Name:PARIS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 WASHINGTON BLVD APT 1110
Mailing Address - Street 2:
Mailing Address - City:MARINA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90292-5090
Mailing Address - Country:US
Mailing Address - Phone:310-821-0502
Mailing Address - Fax:
Practice Address - Street 1:415 WASHINGTON BLVD APT 1110
Practice Address - Street 2:
Practice Address - City:MARINA DEL REY
Practice Address - State:CA
Practice Address - Zip Code:90292-5090
Practice Address - Country:US
Practice Address - Phone:310-821-0502
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-28
Last Update Date:2016-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT 24594106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist