Provider Demographics
NPI:1780962043
Name:LANDA, ALLISON MAE (MA, LMFT)
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:MAE
Last Name:LANDA
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25096 JEFFERSON AVE STE C
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92562-1706
Mailing Address - Country:US
Mailing Address - Phone:909-224-2283
Mailing Address - Fax:
Practice Address - Street 1:25096 JEFFERSON AVE STE C
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562-1706
Practice Address - Country:US
Practice Address - Phone:951-268-0556
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-03
Last Update Date:2020-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA64422106H00000X
CA53342106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1780962043OtherNPI
CACB226559Medicaid
CACA140083Medicaid
CA1386277135OtherNPI
CA53342OtherBBS