1700469970 NPI number — THE CHANGE MOVEMENT A MARRIAGE AND FAMILY THERAPY CORPORATION

Table of content: (NPI 1700469970)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700469970 NPI number — THE CHANGE MOVEMENT A MARRIAGE AND FAMILY THERAPY CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE CHANGE MOVEMENT A MARRIAGE AND FAMILY THERAPY CORPORATION
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:
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:
1700469970
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/04/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
22287 MULHOLLAND HWY # 552
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CALABASAS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91302-5157
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
747-474-2325
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2001 S BARRINGTON AVE STE 203
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90025-5385
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
747-474-2325
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/04/2021

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
CARTER
Authorized Official First Name:
ALFRED
Authorized Official Middle Name:
RENARD
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
310-908-4598

Provider Taxonomy Codes

  • Taxonomy code: 261QM0801X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QM0850X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM0855X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 1356476089 . This is a "A RENARD CARTER LMFT" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 1356476089 . This is a "ALFRED R CARTER LMFT" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".