Provider Demographics
NPI:1275286486
Name:11-10 THERAPY, A MARRIAGE AND FAMILY THERAPY CORP
Entity Type:Organization
Organization Name:11-10 THERAPY, A MARRIAGE AND FAMILY THERAPY CORP
Other - Org Name:11-10 THERAPY, A MARRIAGE AND FAMILY THERAPY CORP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MARIAGE AND FAMILY THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:CORY
Authorized Official - Middle Name:L
Authorized Official - Last Name:CANDELAS
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:951-275-3756
Mailing Address - Street 1:3400 CENTRAL AVE STE 310
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92506-2181
Mailing Address - Country:US
Mailing Address - Phone:951-275-3756
Mailing Address - Fax:
Practice Address - Street 1:3400 CENTRAL AVE STE 310
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-2181
Practice Address - Country:US
Practice Address - Phone:951-275-3756
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-28
Last Update Date:2022-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty