Provider Demographics
NPI:1780776971
Name:HEAD, BERTHA HELEN (MA LMFT)
Entity type:Individual
Prefix:MRS
First Name:BERTHA
Middle Name:HELEN
Last Name:HEAD
Suffix:
Gender:F
Credentials:MA LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5123 JARVIS AVE
Mailing Address - Street 2:
Mailing Address - City:LA CANADA
Mailing Address - State:CA
Mailing Address - Zip Code:91011-1642
Mailing Address - Country:US
Mailing Address - Phone:818-790-2290
Mailing Address - Fax:818-790-5064
Practice Address - Street 1:850 COLORADO BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90041-1738
Practice Address - Country:US
Practice Address - Phone:332-325-4608
Practice Address - Fax:818-790-5064
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC39297106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist