Provider Demographics
NPI:1811472996
Name:ERIKA DAHLE PETRAS MARRIAGE AND FAMILY THERAPY A PROFESSIONAL CORP
Entity type:Organization
Organization Name:ERIKA DAHLE PETRAS MARRIAGE AND FAMILY THERAPY A PROFESSIONAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ERIKA
Authorized Official - Middle Name:DAHLE
Authorized Official - Last Name:PETRAS
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:818-817-1871
Mailing Address - Street 1:100 E THOUSAND OAKS BLVD STE 234
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91360-8156
Mailing Address - Country:US
Mailing Address - Phone:818-817-1871
Mailing Address - Fax:
Practice Address - Street 1:520 S SEPULVEDA BLVD STE 409
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90049-3547
Practice Address - Country:US
Practice Address - Phone:818-817-1871
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-25
Last Update Date:2018-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty