Provider Demographics
NPI:1053906347
Name:ANNON, JEFFREY JOAL (LMFT)
Entity type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:JOAL
Last Name:ANNON
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5950 BUCKINGHAM PKWY UNIT 401
Mailing Address - Street 2:
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90230-6776
Mailing Address - Country:US
Mailing Address - Phone:310-938-1450
Mailing Address - Fax:
Practice Address - Street 1:7915 LINDLEY AVE
Practice Address - Street 2:
Practice Address - City:RESEDA
Practice Address - State:CA
Practice Address - Zip Code:91335-2122
Practice Address - Country:US
Practice Address - Phone:818-302-0712
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-08
Last Update Date:2023-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAMFT114582106H00000X
CALMFT130948106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist