Provider Demographics
NPI:1063026961
Name:LA THERAPY & FAMILY COUNSELING, INC
Entity type:Organization
Organization Name:LA THERAPY & FAMILY COUNSELING, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:REYES
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:213-604-4007
Mailing Address - Street 1:PO BOX 10563
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91510-0563
Mailing Address - Country:US
Mailing Address - Phone:323-484-8826
Mailing Address - Fax:
Practice Address - Street 1:800 S VICTORY BLVD STE 106
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91502-2489
Practice Address - Country:US
Practice Address - Phone:323-484-8826
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-08
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA9999999Medicaid