Provider Demographics
NPI:1205405420
Name:INNER FREEDOM INDIVIDUAL, RELATIONSHIP, AND MARRIAGE COUNSELING CORP
Entity Type:Organization
Organization Name:INNER FREEDOM INDIVIDUAL, RELATIONSHIP, AND MARRIAGE COUNSELING CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TRIVA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:PONDER
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:310-993-8255
Mailing Address - Street 1:9663 SANTA MONICA BLVD # 862
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-4303
Mailing Address - Country:US
Mailing Address - Phone:310-993-8255
Mailing Address - Fax:
Practice Address - Street 1:415 N CAMDEN DR STE 214
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-4439
Practice Address - Country:US
Practice Address - Phone:310-993-8255
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-22
Last Update Date:2021-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty