Provider Demographics
NPI:1316107048
Name:MALIJEN, ANNETTE (MFT)
Entity type:Individual
Prefix:
First Name:ANNETTE
Middle Name:
Last Name:MALIJEN
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:622 S LIVE OAK DR
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92805-4814
Mailing Address - Country:US
Mailing Address - Phone:714-935-7538
Mailing Address - Fax:
Practice Address - Street 1:622 S LIVE OAK DR
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92805-4814
Practice Address - Country:US
Practice Address - Phone:714-935-7538
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-16
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC36570106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist