Ilissa Banhazl's National Provider Identifier (NPI) Details
Ilissa Banhazl, MFT
NPI: 1528891777
Enumeration Date: 2024-08-22
Last updated: 2024-08-22
Sole Proprietor: YES
Status: active
Postal Address: 240 CRESCENT GLEN DR, GLENDORA, CA
Phone: 626-664-5924
Primary Practice Address: 240 CRESCENT GLEN DR, GLENDORA, CA
Practice's phone: 626-664-5924