Provider Demographics
NPI:1306596507
Name:ANTOINETTE DE LEON LICENSED MARRIAGE AND FAMILY THERAPIST INC
Entity type:Organization
Organization Name:ANTOINETTE DE LEON LICENSED MARRIAGE AND FAMILY THERAPIST INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ANTOINETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:DE LEON
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:818-421-7020
Mailing Address - Street 1:4930 BALBOA BLVD #261054
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91426-7052
Mailing Address - Country:US
Mailing Address - Phone:818-421-7020
Mailing Address - Fax:
Practice Address - Street 1:16060 VENTURA BLVD
Practice Address - Street 2:UNIT 110 PMB 1012
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-4916
Practice Address - Country:US
Practice Address - Phone:818-421-7020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-28
Last Update Date:2022-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty