Provider Demographics
NPI:1063578391
Name:STANLEY, ANITA (MFT)
Entity type:Individual
Prefix:
First Name:ANITA
Middle Name:
Last Name:STANLEY
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4529 SHERMAN OAKS AVE
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91403-3820
Mailing Address - Country:US
Mailing Address - Phone:818-783-7818
Mailing Address - Fax:
Practice Address - Street 1:4529 SHERMAN OAKS AVE
Practice Address - Street 2:
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91403-3820
Practice Address - Country:US
Practice Address - Phone:818-783-7818
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC7298101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health