Provider Demographics
NPI:1043671845
Name:INDIVIDUAL, COUPLES AND FAMILY THERAPY INC.
Entity Type:Organization
Organization Name:INDIVIDUAL, COUPLES AND FAMILY THERAPY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CAITLIN
Authorized Official - Middle Name:
Authorized Official - Last Name:TONDA
Authorized Official - Suffix:
Authorized Official - Credentials:MFT
Authorized Official - Phone:310-431-7532
Mailing Address - Street 1:10811 WASHINGTON BLVD STE 301
Mailing Address - Street 2:
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90232-3666
Mailing Address - Country:US
Mailing Address - Phone:310-431-7532
Mailing Address - Fax:
Practice Address - Street 1:10811 WASHINGTON BLVD STE 301
Practice Address - Street 2:
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90232-3666
Practice Address - Country:US
Practice Address - Phone:310-431-7532
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-08
Last Update Date:2016-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC49377261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1245523182OtherINDIVIDUAL NPI #