Provider Demographics
NPI:1174364202
Name:FECSKE, PAIGE E (LMFT)
Entity type:Individual
Prefix:
First Name:PAIGE
Middle Name:E
Last Name:FECSKE
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 1:4804 LAUREL CANYON BLVD # 812
Mailing Address - Street 2:
Mailing Address - City:VALLEY VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91607-3717
Mailing Address - Country:US
Mailing Address - Phone:310-995-5017
Mailing Address - Fax:
Practice Address - Street 1:11114 VALLEY SPRING LN
Practice Address - Street 2:
Practice Address - City:STUDIO CITY
Practice Address - State:CA
Practice Address - Zip Code:91602-2615
Practice Address - Country:US
Practice Address - Phone:818-269-4271
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-03
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA146229106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist