Provider Demographics
NPI:1801925318
Name:QUACH, DONNA (MFTI)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:QUACH
Suffix:
Gender:F
Credentials:MFTI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4405 W RIVERSIDE DR
Mailing Address - Street 2:SUITE #203
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91505-4072
Mailing Address - Country:US
Mailing Address - Phone:818-588-7141
Mailing Address - Fax:818-385-0253
Practice Address - Street 1:4405 W RIVERSIDE DR
Practice Address - Street 2:SUITE #203
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505-4072
Practice Address - Country:US
Practice Address - Phone:818-588-7141
Practice Address - Fax:818-385-0253
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2013-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46794106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist