Provider Demographics
NPI:1720295967
Name:ASANOVICH, TERRI L (MFT)
Entity Type:Individual
Prefix:
First Name:TERRI
Middle Name:L
Last Name:ASANOVICH
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15233 VENTURA BLVD
Mailing Address - Street 2:#1204
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91403-2201
Mailing Address - Country:US
Mailing Address - Phone:818-906-3734
Mailing Address - Fax:818-990-5143
Practice Address - Street 1:15233 VENTURA BLVD
Practice Address - Street 2:#1204
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91403-2201
Practice Address - Country:US
Practice Address - Phone:818-906-3734
Practice Address - Fax:818-990-5143
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMFT120910OtherBLUE SHIELD