Provider Demographics
NPI:1336853696
Name:ARCHER, DEJAH
Entity type:Individual
Prefix:
First Name:DEJAH
Middle Name:
Last Name:ARCHER
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1625 W OLYMPIC BLVD STE 600
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90015-3865
Mailing Address - Country:US
Mailing Address - Phone:323-999-2404
Mailing Address - Fax:
Practice Address - Street 1:1625 W OLYMPIC BLVD STE 600
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90015-3865
Practice Address - Country:US
Practice Address - Phone:323-999-2404
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-11
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAMFT149384106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA7667OtherMEDICAL
CA7708OtherMEDICAL
CA7184OtherMEDICAL
CA7368OtherMEDICAL