Provider Demographics
NPI:1730306424
Name:PILGRIMAGE FAMILY THERAPY
Entity Type:Organization
Organization Name:PILGRIMAGE FAMILY THERAPY
Other - Org Name:PILGRIMAGE FAMILY COUNSELING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:DONALD
Authorized Official - Last Name:WINANDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-460-5320
Mailing Address - Street 1:23201 MILL CREEK DR
Mailing Address - Street 2:STE 200
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-7905
Mailing Address - Country:US
Mailing Address - Phone:949-460-5320
Mailing Address - Fax:949-460-5322
Practice Address - Street 1:23201 MILL CREEK DR
Practice Address - Street 2:STE 200
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-7905
Practice Address - Country:US
Practice Address - Phone:949-460-5320
Practice Address - Fax:949-460-5322
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC27432106H00000X
CAMC23624106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty