Provider Demographics
NPI:1801436019
Name:ENGAGE TREATMENT PROGRAM, INC
Entity type:Organization
Organization Name:ENGAGE TREATMENT PROGRAM, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ADELINA
Authorized Official - Middle Name:MEHRAZARIN
Authorized Official - Last Name:BRISBOIS
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:949-510-5852
Mailing Address - Street 1:4607 LAKEVIEW CANYON RD
Mailing Address - Street 2:PMB 407
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91361
Mailing Address - Country:US
Mailing Address - Phone:805-497-0605
Mailing Address - Fax:805-371-4862
Practice Address - Street 1:2625 TOWNSGATE RD STE 210
Practice Address - Street 2:
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91361-5754
Practice Address - Country:US
Practice Address - Phone:805-497-0605
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-15
Last Update Date:2024-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health