Provider Demographics
NPI:1558720904
Name:PACIFIC MARRIAGE & FAMILY THERAPY NETWORK, A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:PACIFIC MARRIAGE & FAMILY THERAPY NETWORK, A PROFESSIONAL CORPORATION
Other - Org Name:PACIFIC MFT NETWORK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:KOVACS
Authorized Official - Last Name:BEVINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:MA, MFT
Authorized Official - Phone:310-226-2826
Mailing Address - Street 1:2716 OCEAN PARK BLVD STE 3075
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90405-5232
Mailing Address - Country:US
Mailing Address - Phone:310-612-2998
Mailing Address - Fax:310-943-2590
Practice Address - Street 1:2716 OCEAN PARK BLVD STE 3075
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90405-5232
Practice Address - Country:US
Practice Address - Phone:310-612-2998
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-14
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53455106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty