1922490952 NPI number — TEEN THERAPY CENTER, A MARRIAGE AND FAMILY COUNSELING PROFESSIONAL COR

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922490952 NPI number — TEEN THERAPY CENTER, A MARRIAGE AND FAMILY COUNSELING PROFESSIONAL COR

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TEEN THERAPY CENTER, A MARRIAGE AND FAMILY COUNSELING PROFESSIONAL COR
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1922490952
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/27/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6400 CANOGA AVE
Provider Second Line Business Mailing Address:
SUITE 312
Provider Business Mailing Address City Name:
WOODLAND HILLS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91367-2425
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
818-983-7728
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6400 CANOGA AVE
Provider Second Line Business Practice Location Address:
SUITE 312
Provider Business Practice Location Address City Name:
WOODLAND HILLS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91367-2425
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-983-7728
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/27/2015

Additional Information

Authorized Official

Authorized Official Last Name:
TOUSSAINT
Authorized Official First Name:
KENT
Authorized Official Middle Name:
MITCHELL
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
818-983-7728

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X , with the licence number:  MFC 44685 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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