Provider Demographics
NPI:1225506983
Name:MIDWEST COUNSELING AND FAMILY SERVICES INC.
Entity Type:Organization
Organization Name:MIDWEST COUNSELING AND FAMILY SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:KENDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:THEROITH
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:951-364-4775
Mailing Address - Street 1:8605 SANTA MONICA BLVD # 98038
Mailing Address - Street 2:
Mailing Address - City:WEST HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90069-4109
Mailing Address - Country:US
Mailing Address - Phone:951-364-4775
Mailing Address - Fax:
Practice Address - Street 1:448 E FOOTHILL BLVD STE 210
Practice Address - Street 2:
Practice Address - City:SAN DIMAS
Practice Address - State:CA
Practice Address - Zip Code:91773-1221
Practice Address - Country:US
Practice Address - Phone:951-364-4775
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-10
Last Update Date:2018-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty