Provider Demographics
NPI:1225720493
Name:MONTERROZA MARRIAGE AND FAMILY THERAPY INC
Entity Type:Organization
Organization Name:MONTERROZA MARRIAGE AND FAMILY THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:JEANINE
Authorized Official - Middle Name:AIME
Authorized Official - Last Name:MONTERROZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:213-270-4009
Mailing Address - Street 1:508 GLENWOOD RD APT 306
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91202-4502
Mailing Address - Country:US
Mailing Address - Phone:213-270-4009
Mailing Address - Fax:
Practice Address - Street 1:508 GLENWOOD RD APT 306
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91202-4502
Practice Address - Country:US
Practice Address - Phone:213-270-4009
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-24
Last Update Date:2023-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty