Provider Demographics
NPI:1407426638
Name:SOUTH BAY FAMILY COUNSELING CORP.
Entity Type:Organization
Organization Name:SOUTH BAY FAMILY COUNSELING CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MEGAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HIGINBOTHAM
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:310-713-5026
Mailing Address - Street 1:25550 HAWTHORNE BLVD STE 316
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-6832
Mailing Address - Country:US
Mailing Address - Phone:310-713-5026
Mailing Address - Fax:
Practice Address - Street 1:25550 HAWTHORNE BLVD STE 316
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-6832
Practice Address - Country:US
Practice Address - Phone:310-713-5026
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTH BAY FAMILY COUNSELING CORP.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-06-29
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty