Provider Demographics
NPI:1477821486
Name:ACCIDENT INJURY AND FAMILY THERAPY, INC
Entity Type:Organization
Organization Name:ACCIDENT INJURY AND FAMILY THERAPY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:FRANKLIN
Authorized Official - Last Name:WORKMAN
Authorized Official - Suffix:III
Authorized Official - Credentials:PH, D
Authorized Official - Phone:714-505-2093
Mailing Address - Street 1:PO BOX 6646
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92863-6646
Mailing Address - Country:US
Mailing Address - Phone:714-505-2093
Mailing Address - Fax:714-573-0072
Practice Address - Street 1:17821 EAST 17TH ST
Practice Address - Street 2:SUITE 250
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780
Practice Address - Country:US
Practice Address - Phone:714-505-2093
Practice Address - Fax:714-573-0072
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-05
Last Update Date:2011-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT14419103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty