Provider Demographics
NPI:1912440488
Name:ARCHBOLD PETTIS WINSLOW, JANE (LMFT)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:
Last Name:ARCHBOLD PETTIS WINSLOW
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5601 W SLAUSON AVE
Mailing Address - Street 2:SUITE 192
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90230-6582
Mailing Address - Country:US
Mailing Address - Phone:424-331-9070
Mailing Address - Fax:310-873-3315
Practice Address - Street 1:5601 W SLAUSON AVE
Practice Address - Street 2:SUITE 192
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90230-6582
Practice Address - Country:US
Practice Address - Phone:424-331-9070
Practice Address - Fax:310-873-3315
Is Sole Proprietor?:No
Enumeration Date:2016-11-30
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT50716106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist