Provider Demographics
NPI:1942353537
Name:VISTA CENTER FOR COUNSELING AND PSYCHOTHERAPY
Entity Type:Organization
Organization Name:VISTA CENTER FOR COUNSELING AND PSYCHOTHERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:T
Authorized Official - Last Name:DOUSETTE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD MFT
Authorized Official - Phone:818-980-0202
Mailing Address - Street 1:4507 AUCKLAND AVE
Mailing Address - Street 2:
Mailing Address - City:TOLUCA LAKE
Mailing Address - State:CA
Mailing Address - Zip Code:91602
Mailing Address - Country:US
Mailing Address - Phone:818-980-0202
Mailing Address - Fax:818-952-9044
Practice Address - Street 1:4507 AUCKLAND AVE
Practice Address - Street 2:
Practice Address - City:TOLUCA LAKE
Practice Address - State:CA
Practice Address - Zip Code:91602
Practice Address - Country:US
Practice Address - Phone:818-980-0202
Practice Address - Fax:818-952-9044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY18158103TC0700X
CAMK22157106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty