Provider Demographics
NPI:1154580819
Name:SUDETH, ANNA GREEN GRIFFIN (LMFT)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:GREEN GRIFFIN
Last Name:SUDETH
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:ANNA
Other - Middle Name:GREEN
Other - Last Name:GRIFFIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:46-E PENINSULA CENTER DRIVE #527
Mailing Address - Street 2:
Mailing Address - City:ROLLING HILLS ESTATES
Mailing Address - State:CA
Mailing Address - Zip Code:90274-3562
Mailing Address - Country:US
Mailing Address - Phone:626-564-1613
Mailing Address - Fax:
Practice Address - Street 1:2500 E FOOTHILL BLVD
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91107-3464
Practice Address - Country:US
Practice Address - Phone:626-564-1613
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-06
Last Update Date:2019-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA89487106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist