Provider Demographics
NPI:1518018068
Name:FASAN, LINDA ANNE (MFT)
Entity type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:ANNE
Last Name:FASAN
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 1:14326 CHANDLER BLVD APT 3
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91401-5500
Mailing Address - Country:US
Mailing Address - Phone:818-231-7175
Mailing Address - Fax:818-981-0583
Practice Address - Street 1:14156 MAGNOLIA BLVD STE 105
Practice Address - Street 2:
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91423-6410
Practice Address - Country:US
Practice Address - Phone:818-231-7175
Practice Address - Fax:818-981-0583
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC39937106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist