Provider Demographics
NPI:1164148946
Name:COUNSELORS FOR CHANGE INC., INDIVIDUAL AND FAMILY THERAPIST CO
Entity Type:Organization
Organization Name:COUNSELORS FOR CHANGE INC., INDIVIDUAL AND FAMILY THERAPIST CO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TINA
Authorized Official - Middle Name:M
Authorized Official - Last Name:SALAZAR
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:323-202-3860
Mailing Address - Street 1:1818 W BEVERLY BLVD STE 207
Mailing Address - Street 2:
Mailing Address - City:MONTEBELLO
Mailing Address - State:CA
Mailing Address - Zip Code:90640-3968
Mailing Address - Country:US
Mailing Address - Phone:213-238-7502
Mailing Address - Fax:
Practice Address - Street 1:1818 W BEVERLY BLVD STE 207
Practice Address - Street 2:
Practice Address - City:MONTEBELLO
Practice Address - State:CA
Practice Address - Zip Code:90640-3968
Practice Address - Country:US
Practice Address - Phone:213-238-7502
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-13
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty