Provider Demographics
NPI:1184439911
Name:MARRIOTT, ANYA TRUDE (AMFT)
Entity type:Individual
Prefix:
First Name:ANYA
Middle Name:TRUDE
Last Name:MARRIOTT
Suffix:
Gender:F
Credentials:AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4100 W ALAMEDA AVE FL 3
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91505-4191
Mailing Address - Country:US
Mailing Address - Phone:323-547-2662
Mailing Address - Fax:
Practice Address - Street 1:4100 W ALAMEDA AVE FL 3
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505-4191
Practice Address - Country:US
Practice Address - Phone:323-547-2662
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-10
Last Update Date:2025-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAMFT152698101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty