Provider Demographics
NPI:1306104286
Name:WILLIS, DAREN ELISE (LMFT)
Entity type:Individual
Prefix:MS
First Name:DAREN
Middle Name:ELISE
Last Name:WILLIS
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:MS
Other - First Name:DAREN
Other - Middle Name:ELISE
Other - Last Name:LAWE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMFT
Mailing Address - Street 1:10200 SEPULVEDA BLVD STE 180
Mailing Address - Street 2:
Mailing Address - City:MISSION HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91345-2654
Mailing Address - Country:US
Mailing Address - Phone:818-601-0489
Mailing Address - Fax:818-698-6555
Practice Address - Street 1:10200 SEPULVEDA BLVD STE 180
Practice Address - Street 2:
Practice Address - City:MISSION HILLS
Practice Address - State:CA
Practice Address - Zip Code:91345-2654
Practice Address - Country:US
Practice Address - Phone:818-672-6338
Practice Address - Fax:818-698-6555
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-27
Last Update Date:2019-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC51214106H00000X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist