Provider Demographics
NPI:1659944361
Name:BETH HOLDER LICENSED MARRIAGE AND FAMILY THERAPY INC
Entity Type:Organization
Organization Name:BETH HOLDER LICENSED MARRIAGE AND FAMILY THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BETHANY
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLDER
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:949-842-7884
Mailing Address - Street 1:302 N EL CAMINO REAL STE 202
Mailing Address - Street 2:
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92672-4778
Mailing Address - Country:US
Mailing Address - Phone:949-842-7884
Mailing Address - Fax:949-272-5541
Practice Address - Street 1:302 N EL CAMINO REAL STE 202
Practice Address - Street 2:
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92672-4778
Practice Address - Country:US
Practice Address - Phone:949-842-7884
Practice Address - Fax:949-272-5541
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-20
Last Update Date:2021-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty