Provider Demographics
NPI:1104961895
Name:VANOUNTS, MARIAM (LMFT)
Entity type:Individual
Prefix:MISS
First Name:MARIAM
Middle Name:
Last Name:VANOUNTS
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 1:326 E FAIRVIEW AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91207-1998
Mailing Address - Country:US
Mailing Address - Phone:818-406-7979
Mailing Address - Fax:
Practice Address - Street 1:655 N CENTRAL AVE # 1763
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91203-1422
Practice Address - Country:US
Practice Address - Phone:818-406-7979
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2020-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47199106H00000X
CA46212106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist