Provider Demographics
NPI:1386786523
Name:IVES, ERICA LYNN (MA, MFT)
Entity type:Individual
Prefix:MRS
First Name:ERICA
Middle Name:LYNN
Last Name:IVES
Suffix:
Gender:F
Credentials:MA, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21243 VENTURA BLVD STE 137
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91364-2124
Mailing Address - Country:US
Mailing Address - Phone:818-715-9517
Mailing Address - Fax:818-715-0824
Practice Address - Street 1:21243 VENTURA BLVD STE 137
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91364-2124
Practice Address - Country:US
Practice Address - Phone:818-715-9517
Practice Address - Fax:818-715-0824
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2009-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT#34566106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist