Provider Demographics
NPI:1174268700
Name:ZEPHYR, A MARRIAGE AND FAMILY THERAPY PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:ZEPHYR, A MARRIAGE AND FAMILY THERAPY PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:D
Authorized Official - Last Name:KILPATRICK
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:555-555-5555
Mailing Address - Street 1:55 W SIERRA MADRE BLVD STE 203
Mailing Address - Street 2:
Mailing Address - City:SIERRA MADRE
Mailing Address - State:CA
Mailing Address - Zip Code:91024-3017
Mailing Address - Country:US
Mailing Address - Phone:626-658-3865
Mailing Address - Fax:
Practice Address - Street 1:55 W SIERRA MADRE BLVD STE 203
Practice Address - Street 2:
Practice Address - City:SIERRA MADRE
Practice Address - State:CA
Practice Address - Zip Code:91024-3017
Practice Address - Country:US
Practice Address - Phone:626-658-3865
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-28
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)