Provider Demographics
NPI:1386408086
Name:VALLEY PSYCHOTHERAPY GROUP INC
Entity type:Organization
Organization Name:VALLEY PSYCHOTHERAPY GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:CAMILLE
Authorized Official - Middle Name:
Authorized Official - Last Name:ORTANEZ
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD, LCSW
Authorized Official - Phone:818-922-4367
Mailing Address - Street 1:20501 VENTURA BLVD STE 213
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91364-0847
Mailing Address - Country:US
Mailing Address - Phone:818-922-4367
Mailing Address - Fax:
Practice Address - Street 1:20501 VENTURA BLVD STE 213
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91364-0847
Practice Address - Country:US
Practice Address - Phone:818-922-4367
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-13
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1407083678OtherHEALTH NET
CA1407083678Medicaid
CA1407083678OtherEVERNORTH
CA1407083678OtherANTHEM BLUE CROSS