Provider Demographics
NPI:1306675566
Name:BOUSKILA, ORLY F (MFT)
Entity type:Individual
Prefix:
First Name:ORLY
Middle Name:F
Last Name:BOUSKILA
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:313 GRAND BLVD # 1823
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:CA
Mailing Address - Zip Code:90291-4234
Mailing Address - Country:US
Mailing Address - Phone:310-289-4310
Mailing Address - Fax:
Practice Address - Street 1:313 GRAND BLVD # 1823
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:CA
Practice Address - Zip Code:90291-4234
Practice Address - Country:US
Practice Address - Phone:310-289-4310
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-27
Last Update Date:2024-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35429106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist