Provider Demographics
NPI: | 1497517957 |
---|---|
Name: | BALANCED HEART MARRIAGE AND FAMILY THERAPY INC. |
Entity Type: | Organization |
Organization Name: | BALANCED HEART MARRIAGE AND FAMILY THERAPY INC. |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | CEO |
Authorized Official - Prefix: | |
Authorized Official - First Name: | KAREN |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | RIVAS COBAR |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | LMFT |
Authorized Official - Phone: | 818-923-0717 |
Mailing Address - Street 1: | 14622 VENTURA BLVD STE 102 |
Mailing Address - Street 2: | |
Mailing Address - City: | SHERMAN OAKS |
Mailing Address - State: | CA |
Mailing Address - Zip Code: | 91403-3662 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 323-677-4871 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 16530 VENTURA BLVD STE 400 |
Practice Address - Street 2: | |
Practice Address - City: | ENCINO |
Practice Address - State: | CA |
Practice Address - Zip Code: | 91436-4551 |
Practice Address - Country: | US |
Practice Address - Phone: | 323-677-4871 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2024-01-29 |
Last Update Date: | 2024-01-29 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 261QM0801X | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) |