Provider Demographics
NPI:1235580556
Name:MARRIAGE MADE BETTER RELATIONSHIP COUNSELING
Entity Type:Organization
Organization Name:MARRIAGE MADE BETTER RELATIONSHIP COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LMFT
Authorized Official - Prefix:
Authorized Official - First Name:CARLY
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:KETCHUM
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:949-391-1812
Mailing Address - Street 1:47 CORTE VIDRIOSA
Mailing Address - Street 2:
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92673
Mailing Address - Country:US
Mailing Address - Phone:949-391-1812
Mailing Address - Fax:
Practice Address - Street 1:30200 RANCHO VIEJO ROAD, SUITE D
Practice Address - Street 2:
Practice Address - City:SAN JUAN CAPISTRANO
Practice Address - State:CA
Practice Address - Zip Code:92675
Practice Address - Country:US
Practice Address - Phone:949-391-1812
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-28
Last Update Date:2018-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT81406251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health