Provider Demographics
NPI:1124593413
Name:EAST WEST HOLISTIC PSYCHOTHERAPY A MARRIAGE AND FAMILY THERAPY CORPORA
Entity Type:Organization
Organization Name:EAST WEST HOLISTIC PSYCHOTHERAPY A MARRIAGE AND FAMILY THERAPY CORPORA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:ERIN
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:MCGINNIS
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:310-975-3110
Mailing Address - Street 1:2510 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90405-3535
Mailing Address - Country:US
Mailing Address - Phone:310-975-3110
Mailing Address - Fax:
Practice Address - Street 1:2510 MAIN ST
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90405-3535
Practice Address - Country:US
Practice Address - Phone:310-975-3110
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-12
Last Update Date:2018-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty