Provider Demographics
NPI:1235763574
Name:HOPE AVENUE MARRIAGE AND FAMILY THERAPY INC.
Entity Type:Organization
Organization Name:HOPE AVENUE MARRIAGE AND FAMILY THERAPY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, CEO
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:SHAWN
Authorized Official - Last Name:CARSON
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT 111892
Authorized Official - Phone:909-708-5849
Mailing Address - Street 1:1400 E COOLEY DR STE 200A
Mailing Address - Street 2:
Mailing Address - City:COLTON
Mailing Address - State:CA
Mailing Address - Zip Code:92324-3939
Mailing Address - Country:US
Mailing Address - Phone:909-295-5295
Mailing Address - Fax:909-295-5295
Practice Address - Street 1:1400 E COOLEY DR STE 200A
Practice Address - Street 2:
Practice Address - City:COLTON
Practice Address - State:CA
Practice Address - Zip Code:92324-3939
Practice Address - Country:US
Practice Address - Phone:909-295-5295
Practice Address - Fax:909-295-5295
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-25
Last Update Date:2020-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health