Provider Demographics
NPI:1083006944
Name:MARRIAGE & FAMILY THERAPY SERVICES, INC.
Entity Type:Organization
Organization Name:MARRIAGE & FAMILY THERAPY SERVICES, INC.
Other - Org Name:BRIGHT ROAD RECOVERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TAMSON
Authorized Official - Middle Name:
Authorized Official - Last Name:OVERHOLTZER
Authorized Official - Suffix:
Authorized Official - Credentials:MFT
Authorized Official - Phone:909-624-7070
Mailing Address - Street 1:428 HARRISON AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CLAREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:91711-4605
Mailing Address - Country:US
Mailing Address - Phone:909-994-1436
Mailing Address - Fax:
Practice Address - Street 1:428 HARRISON AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:CLAREMONT
Practice Address - State:CA
Practice Address - Zip Code:91711-4605
Practice Address - Country:US
Practice Address - Phone:909-994-1436
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-02
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental HealthGroup - Multi-Specialty
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health