Provider Demographics
NPI:1801955653
Name:SUSSMAN, ILENA TRISH (MA, LMFT)
Entity type:Individual
Prefix:MISS
First Name:ILENA
Middle Name:TRISH
Last Name:SUSSMAN
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 2468
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93002
Mailing Address - Country:US
Mailing Address - Phone:805-372-0406
Mailing Address - Fax:
Practice Address - Street 1:1000 S HILL RD
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-4455
Practice Address - Country:US
Practice Address - Phone:707-280-2641
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-07
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA89951106H00000X
CA79272101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist