Provider Demographics
NPI:1720556129
Name:MULTICULTURAL THERAPY INTERNSHIP AND TRAINING CENTER INC.
Entity Type:Organization
Organization Name:MULTICULTURAL THERAPY INTERNSHIP AND TRAINING CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:REEVES
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT, PHD
Authorized Official - Phone:714-794-5172
Mailing Address - Street 1:12821 NEWPORT AVE
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-2711
Mailing Address - Country:US
Mailing Address - Phone:714-794-5172
Mailing Address - Fax:
Practice Address - Street 1:12821 NEWPORT AVE
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-2711
Practice Address - Country:US
Practice Address - Phone:714-794-5172
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-05
Last Update Date:2018-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty