Provider Demographics
NPI:1093460388
Name:BLUE CHAIR FAMILY THERAPY
Entity Type:Organization
Organization Name:BLUE CHAIR FAMILY THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL THERAPIST/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:M
Authorized Official - Last Name:CORNWALL
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:213-379-6453
Mailing Address - Street 1:2512 ARTESIA BLVD STE 250F
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90278-5365
Mailing Address - Country:US
Mailing Address - Phone:424-255-8483
Mailing Address - Fax:
Practice Address - Street 1:2512 ARTESIA BLVD STE 250F
Practice Address - Street 2:
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90278-5365
Practice Address - Country:US
Practice Address - Phone:424-255-8483
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-16
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty