Provider Demographics
NPI:1609304716
Name:DR ANNA SELENA CHO, CHILD & FAMILY THERAPIST INC.
Entity Type:Organization
Organization Name:DR ANNA SELENA CHO, CHILD & FAMILY THERAPIST INC.
Other - Org Name:HEART THEORY
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:SELENA
Authorized Official - Last Name:CHO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-880-3825
Mailing Address - Street 1:169 PIER AVENUE
Mailing Address - Street 2:SUITE 5
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90405-5311
Mailing Address - Country:US
Mailing Address - Phone:310-880-3825
Mailing Address - Fax:
Practice Address - Street 1:169 PIER AVENUE
Practice Address - Street 2:SUITE 5
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90405-5311
Practice Address - Country:US
Practice Address - Phone:310-880-3825
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-02
Last Update Date:2020-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106H00000X
CA99936261QM0850X, 261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental HealthGroup - Multi-Specialty