Provider Demographics
NPI:1467910208
Name:SALT MARRIAGE AND FAMILY THERAPY INC
Entity Type:Organization
Organization Name:SALT MARRIAGE AND FAMILY THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:P
Authorized Official - Last Name:KRETZSCHMAR
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:323-999-4638
Mailing Address - Street 1:3815 ATLANTIC AVE STE 6
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90807-3500
Mailing Address - Country:US
Mailing Address - Phone:323-999-4638
Mailing Address - Fax:
Practice Address - Street 1:3815 ATLANTIC AVE STE 6
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90807-3500
Practice Address - Country:US
Practice Address - Phone:323-999-4638
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-12
Last Update Date:2019-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty