Provider Demographics
NPI:1124750732
Name:ALTENBACH, XIAODAN HELEN (AMFT)
Entity type:Individual
Prefix:
First Name:XIAODAN
Middle Name:HELEN
Last Name:ALTENBACH
Suffix:
Gender:F
Credentials:AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1225 CYPRESS AVE
Mailing Address - Street 2:STE 3 #V203
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90065
Mailing Address - Country:US
Mailing Address - Phone:818-641-5883
Mailing Address - Fax:
Practice Address - Street 1:1225 CYPRESS AVE
Practice Address - Street 2:STE 3 #V203
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90065
Practice Address - Country:US
Practice Address - Phone:818-641-5883
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-30
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA132673101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty