Provider Demographics
NPI:1568898765
Name:ASSOCIATES IN COUNSELING & MEDIATION
Entity Type:Organization
Organization Name:ASSOCIATES IN COUNSELING & MEDIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:GANTENBEIN
Authorized Official - Suffix:
Authorized Official - Credentials:CAADAC A3518587
Authorized Official - Phone:562-498-0768
Mailing Address - Street 1:5585 E PACIFIC COAST HWY UNIT 166
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90804-9456
Mailing Address - Country:US
Mailing Address - Phone:562-498-0768
Mailing Address - Fax:
Practice Address - Street 1:265 S ANITA DR STE 117
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-3341
Practice Address - Country:US
Practice Address - Phone:714-978-1090
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-19
Last Update Date:2013-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACAADAC A3518587261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder