Provider Demographics
NPI:1427734763
Name:JANIS, LINZIE NICOLE (AMFT)
Entity type:Individual
Prefix:
First Name:LINZIE
Middle Name:NICOLE
Last Name:JANIS
Suffix:
Gender:F
Credentials:AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 46122
Mailing Address - Street 2:1125 N FAIRFAX AVE
Mailing Address - City:WEST HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90046-9998
Mailing Address - Country:US
Mailing Address - Phone:323-790-6094
Mailing Address - Fax:
Practice Address - Street 1:143 N LARCHMONT BLVD FL 2
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90004-3704
Practice Address - Country:US
Practice Address - Phone:917-716-4537
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-22
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA137882106H00000X
CA13658101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health