Provider Demographics
NPI:1417527961
Name:BECERRA MARRIAGE FAMILY AND CHILD THERAPY
Entity Type:Organization
Organization Name:BECERRA MARRIAGE FAMILY AND CHILD THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JILLY
Authorized Official - Middle Name:
Authorized Official - Last Name:BECERRA
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:818-749-9189
Mailing Address - Street 1:13601 WHITTIER BLVD STE 208
Mailing Address - Street 2:
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90605-1955
Mailing Address - Country:US
Mailing Address - Phone:818-749-9189
Mailing Address - Fax:
Practice Address - Street 1:13601 WHITTIER BLVD STE 208
Practice Address - Street 2:
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90605-1955
Practice Address - Country:US
Practice Address - Phone:818-749-9189
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-28
Last Update Date:2021-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty