Provider Demographics
NPI:1851412381
Name:JOAN C. CONCANNON, MARRIAGE FAMILY THERAPIST
Entity Type:Organization
Organization Name:JOAN C. CONCANNON, MARRIAGE FAMILY THERAPIST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MARRIAGE FAMILY THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JOAN
Authorized Official - Middle Name:C
Authorized Official - Last Name:CONCANNON
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:818-992-0245
Mailing Address - Street 1:PO BOX 622
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91365-0622
Mailing Address - Country:US
Mailing Address - Phone:818-992-0245
Mailing Address - Fax:818-992-0245
Practice Address - Street 1:22231 MULHOLLAND HWY
Practice Address - Street 2:SUITE 202
Practice Address - City:CALABASAS
Practice Address - State:CA
Practice Address - Zip Code:91302-5123
Practice Address - Country:US
Practice Address - Phone:818-992-0245
Practice Address - Fax:818-992-0245
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT20873106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty