Provider Demographics
NPI:1760015705
Name:WHITE GEORGE MARRIAGE & FAMILY THERAPY, INC.
Entity Type:Organization
Organization Name:WHITE GEORGE MARRIAGE & FAMILY THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:MFT
Authorized Official - Phone:310-721-7338
Mailing Address - Street 1:11600 WASHINGTON PL STE 204
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90066-5068
Mailing Address - Country:US
Mailing Address - Phone:310-721-7338
Mailing Address - Fax:
Practice Address - Street 1:11600 WASHINGTON PL STE 204
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90066-5068
Practice Address - Country:US
Practice Address - Phone:310-721-7338
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-18
Last Update Date:2020-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty