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05D2284787 CLIA NUMBER - PROFOUND TREATMENT

Laboratory Demographics

CLIA Number: 05D2284787

Facility Name: PROFOUND TREATMENT

Facility Address:
4725 VANALDEN AVE
TARZANA, CA
ZIP 91356
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Facility Phone Number: 310 600-2395

Facility Type: Other - RES SUD TREATMENT

Certificate Type: Waiver
NPI Number: 1578937637

Taxonomy: 106H00000X - Marriage & Family Therapist
A marriage and family therapist is a person with a master's degree in marriage and family therapy, or a master's or doctoral degree in a related mental health field with substantially equivalent coursework in marriage and family therapy, who receives supervised clinical experience, or a person who meets the state requirements to practice as a marriage and family therapist. A marriage and family therapist treats mental and emotional disorders within the context of marriage and family systems. A marriage and family therapist provides mental health and counseling services to individuals, couples, families, and groups.

CLIA Record

Field Name Field Value
CLIA Number 05D2284787
LAB Type Other - RES SUD TREATMENT
Facility Name PROFOUND TREATMENT
Street 4725 VANALDEN AVE
City TARZANA
State CA
ZIP 91356
Phone 310 600-2395
CertificateType 4
CertificateEffectiveDate 6/28/2023
CertificateExpirationDate 6/27/2025
FacilityType Waiver

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This page was last updated on: 4/23/2024