Provider Demographics
NPI:1497305411
Name:OK 2B ANGRY
Entity Type:Organization
Organization Name:OK 2B ANGRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:SERVANDO
Authorized Official - Middle Name:
Authorized Official - Last Name:TREVINO
Authorized Official - Suffix:SR
Authorized Official - Credentials:LMFT
Authorized Official - Phone:760-638-3095
Mailing Address - Street 1:139 E 3RD AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92025-4246
Mailing Address - Country:US
Mailing Address - Phone:760-896-4357
Mailing Address - Fax:
Practice Address - Street 1:139 E 3RD AVE STE 104
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-4246
Practice Address - Country:US
Practice Address - Phone:760-896-4357
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-12
Last Update Date:2019-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty