Provider Demographics
NPI:1730328063
Name:WOLFF, LAUREN ANITA (MFT)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:ANITA
Last Name:WOLFF
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 1:28632 ROADSIDE DR STE 210
Mailing Address - Street 2:
Mailing Address - City:AGOURA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91301-6091
Mailing Address - Country:US
Mailing Address - Phone:310-402-7775
Mailing Address - Fax:
Practice Address - Street 1:28632 ROADSIDE DR STE 210
Practice Address - Street 2:
Practice Address - City:AGOURA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91301-6091
Practice Address - Country:US
Practice Address - Phone:310-402-7775
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-10
Last Update Date:2022-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46274106H00000X
CAMFC46274101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist