Provider Demographics
NPI:1629668694
Name:CONNECT FAMILY COUNSELING, INC.
Entity Type:Organization
Organization Name:CONNECT FAMILY COUNSELING, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAURYN
Authorized Official - Middle Name:SAYLER
Authorized Official - Last Name:DIVERS
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:626-440-1003
Mailing Address - Street 1:427 S MARENGO AVE STE 4
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101-3134
Mailing Address - Country:US
Mailing Address - Phone:626-440-1003
Mailing Address - Fax:
Practice Address - Street 1:427 S MARENGO AVE STE 4
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-3134
Practice Address - Country:US
Practice Address - Phone:626-440-1003
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-22
Last Update Date:2021-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty