Provider Demographics
NPI:1003452400
Name:INTEGRATED MARRIAGE COUNSELING & CONSULTING PC
Entity Type:Organization
Organization Name:INTEGRATED MARRIAGE COUNSELING & CONSULTING PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:N
Authorized Official - Last Name:MENDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT, CST
Authorized Official - Phone:818-804-1284
Mailing Address - Street 1:20201 ITASCA ST
Mailing Address - Street 2:
Mailing Address - City:CHATSWORTH
Mailing Address - State:CA
Mailing Address - Zip Code:91311-5415
Mailing Address - Country:US
Mailing Address - Phone:818-804-1284
Mailing Address - Fax:
Practice Address - Street 1:21201 VICTORY BLVD STE 200
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91303-2866
Practice Address - Country:US
Practice Address - Phone:818-804-1284
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INTEGRATED MARRIAGE COUNSELING & CONSULTING PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-11-20
Last Update Date:2019-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty