Provider Demographics
NPI:1538698295
Name:COUNSELING CENTER FOR GROWTH AND DEVELOPMENT; A PROFESSIONAL MARRIAGE
Entity Type:Organization
Organization Name:COUNSELING CENTER FOR GROWTH AND DEVELOPMENT; A PROFESSIONAL MARRIAGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:ASHELY
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:661-810-3671
Mailing Address - Street 1:602 COMMERCE AVE STE E
Mailing Address - Street 2:
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93551-3882
Mailing Address - Country:US
Mailing Address - Phone:661-810-3671
Mailing Address - Fax:818-302-2101
Practice Address - Street 1:602 COMMERCE AVE
Practice Address - Street 2:SUITE E
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93551
Practice Address - Country:US
Practice Address - Phone:661-810-3671
Practice Address - Fax:818-302-2101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA93672106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty