Provider Demographics
NPI:1689178717
Name:O.C. FAMILY THERAPY AND WELLNESS
Entity Type:Organization
Organization Name:O.C. FAMILY THERAPY AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:GOLMAR
Authorized Official - Middle Name:
Authorized Official - Last Name:MALEKI
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:949-207-8941
Mailing Address - Street 1:18002 IRVINE BLVD
Mailing Address - Street 2:STE 202-G
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780
Mailing Address - Country:US
Mailing Address - Phone:949-385-3823
Mailing Address - Fax:
Practice Address - Street 1:18002 IRVINE BLVD
Practice Address - Street 2:STE 202-G
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780
Practice Address - Country:US
Practice Address - Phone:949-385-3823
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-22
Last Update Date:2018-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty