Provider Demographics
NPI:1114770955
Name:CALIFORNIA COUPLES AND MARRIAGE COUNSELING, INC
Entity Type:Organization
Organization Name:CALIFORNIA COUPLES AND MARRIAGE COUNSELING, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MOULTRIE
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:559-285-6364
Mailing Address - Street 1:550 W ALLUVIAL AVE STE 108
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93711-5857
Mailing Address - Country:US
Mailing Address - Phone:949-787-1031
Mailing Address - Fax:
Practice Address - Street 1:550 W ALLUVIAL AVE STE 108
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93711-5857
Practice Address - Country:US
Practice Address - Phone:949-787-1031
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-10
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty