Provider Demographics
NPI:1588908826
Name:PARK LOPPNOW, SUNGSHIM (LMFT)
Entity type:Individual
Prefix:
First Name:SUNGSHIM
Middle Name:
Last Name:PARK LOPPNOW
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1628 GLENCOE WAY
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91208-1644
Mailing Address - Country:US
Mailing Address - Phone:626-392-9765
Mailing Address - Fax:
Practice Address - Street 1:1223 VERDUGO BLVD
Practice Address - Street 2:
Practice Address - City:LA CANADA
Practice Address - State:CA
Practice Address - Zip Code:91011-3139
Practice Address - Country:US
Practice Address - Phone:626-392-9765
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-26
Last Update Date:2012-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC45663106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist