Provider Demographics
NPI:1659964575
Name:CONNER FAMILY THERAPY, INC.
Entity Type:Organization
Organization Name:CONNER FAMILY THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LMFT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARITZA
Authorized Official - Middle Name:
Authorized Official - Last Name:CONNER
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT104888
Authorized Official - Phone:818-257-0947
Mailing Address - Street 1:25050 AVENUE KEARNY STE 203
Mailing Address - Street 2:
Mailing Address - City:VALENCIA
Mailing Address - State:CA
Mailing Address - Zip Code:91355-1257
Mailing Address - Country:US
Mailing Address - Phone:818-257-0947
Mailing Address - Fax:
Practice Address - Street 1:25050 AVENUE KEARNY STE 203
Practice Address - Street 2:
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91355-1257
Practice Address - Country:US
Practice Address - Phone:818-257-0947
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-12
Last Update Date:2021-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALMFT104888OtherBOARD OF BEHAVIORAL SCIENCES