Provider Demographics
NPI:1720542574
Name:GRACE OU MARRIAGE AND FAMILY THERAPY
Entity Type:Organization
Organization Name:GRACE OU MARRIAGE AND FAMILY THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:GRACE
Authorized Official - Middle Name:
Authorized Official - Last Name:OU
Authorized Official - Suffix:
Authorized Official - Credentials:MSMFT
Authorized Official - Phone:626-268-0110
Mailing Address - Street 1:1140 OKOBOJI DR UNIT A
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91007-8870
Mailing Address - Country:US
Mailing Address - Phone:626-268-0110
Mailing Address - Fax:
Practice Address - Street 1:1140 OKOBOJI DR UNIT A
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91007-8870
Practice Address - Country:US
Practice Address - Phone:626-268-0110
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-25
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA17202542574OtherNPI
CA1265981740OtherNPI