Provider Demographics
NPI:1740486802
Name:BOURDON, PATRICIA Y (MA, MFT)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:Y
Last Name:BOURDON
Suffix:
Gender:F
Credentials:MA, MFT
Other - Prefix:MISS
Other - First Name:PATRICIA
Other - Middle Name:
Other - Last Name:YELLEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICENSED MFT
Mailing Address - Street 1:141 DUESENBERG DR
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91362-3416
Mailing Address - Country:US
Mailing Address - Phone:818-222-8426
Mailing Address - Fax:
Practice Address - Street 1:141 DUESENBERG DR
Practice Address - Street 2:SUITE 1A
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91362-3416
Practice Address - Country:US
Practice Address - Phone:818-222-8426
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC40870106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA10OtherBEHAVIORAL HEALTH