Provider Demographics
NPI:1619773389
Name:BODYFELT, ADDISON GRACE
Entity type:Individual
Prefix:
First Name:ADDISON
Middle Name:GRACE
Last Name:BODYFELT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9151 DARBY AVE APT 101
Mailing Address - Street 2:
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91325-2251
Mailing Address - Country:US
Mailing Address - Phone:916-699-6880
Mailing Address - Fax:
Practice Address - Street 1:14724 VENTURA BLVD STE 1105
Practice Address - Street 2:
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91403-3510
Practice Address - Country:US
Practice Address - Phone:747-298-3480
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-21
Last Update Date:2025-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician