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1114056629
STACEY DIANE TANNENBAUM
BURBANK, CA
NPI
1114056629
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
Yes
Primary Taxonomy
106H00000X Marriage & Family Therapist
(Licence: CA mfc33404)
Enumeration Date
2007-03-02
Last Update Date
2007-07-08
Business Address
-- STACEY DIANE TANNENBAUM MA. L.M.F.T.
601 S GLENOAKS BLVD SUITE 200
BURBANK, CA 91502-1474
Phone number: 818-441-7800
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Mailing Address
-- STACEY DIANE TANNENBAUM MA. L.M.F.T.
623 ASHLAND AVE #5
SANTA MONICA, CA 90405-4537
Phone number: 310-962-1833
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