Provider Demographics
NPI:1477107530
Name:MARRIAGE & FAMILY THERAPY SERVICES, INC.
Entity Type:Organization
Organization Name:MARRIAGE & FAMILY THERAPY SERVICES, INC.
Other - Org Name:BRIGHT ROAD RECOVERY RESIDENTIAL TREATMENT CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TAMSON
Authorized Official - Middle Name:
Authorized Official - Last Name:OVERHOLTZER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-624-7070
Mailing Address - Street 1:428 HARRISON AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:CLAREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:91711-4605
Mailing Address - Country:US
Mailing Address - Phone:909-624-7070
Mailing Address - Fax:
Practice Address - Street 1:1935 FROSTBURG CIR
Practice Address - Street 2:
Practice Address - City:CLAREMONT
Practice Address - State:CA
Practice Address - Zip Code:91711-2977
Practice Address - Country:US
Practice Address - Phone:909-624-7070
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-27
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility