Provider Demographics
NPI:1932255973
Name:WILLITS-SPOLIN, NILES DARREN (MA MFT)
Entity Type:Individual
Prefix:MR
First Name:NILES
Middle Name:DARREN
Last Name:WILLITS-SPOLIN
Suffix:
Gender:M
Credentials:MA MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22750 MIRANDA ST
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91367-4457
Mailing Address - Country:US
Mailing Address - Phone:818-773-3576
Mailing Address - Fax:818-888-6877
Practice Address - Street 1:16260 VENTURA BLVD
Practice Address - Street 2:SUITE 415
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-2203
Practice Address - Country:US
Practice Address - Phone:818-773-3576
Practice Address - Fax:818-888-6877
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA38351106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist