Provider Demographics
NPI:1801260120
Name:BLATT, ALISA G (MFT)
Entity type:Individual
Prefix:MS
First Name:ALISA
Middle Name:G
Last Name:BLATT
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:ALISA
Other - Middle Name:GABRIELLE
Other - Last Name:BLATT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:22231 MULHOLLAND HWY
Mailing Address - Street 2:#107
Mailing Address - City:CALABASAS
Mailing Address - State:CA
Mailing Address - Zip Code:91302-5123
Mailing Address - Country:US
Mailing Address - Phone:818-419-4272
Mailing Address - Fax:
Practice Address - Street 1:22231 MULHOLLAND HWY
Practice Address - Street 2:#107
Practice Address - City:CALABASAS
Practice Address - State:CA
Practice Address - Zip Code:91302-5123
Practice Address - Country:US
Practice Address - Phone:818-419-4272
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-24
Last Update Date:2015-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT15120106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist