Provider Demographics
NPI:1760156244
Name:VIVIANA BUNTING A MARRIAGE AND FAMILY THERAPY CORPORATION
Entity Type:Organization
Organization Name:VIVIANA BUNTING A MARRIAGE AND FAMILY THERAPY CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:VIVIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:BUNTING
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:951-821-6312
Mailing Address - Street 1:27851 BRADLEY RD STE 130L
Mailing Address - Street 2:
Mailing Address - City:MENIFEE
Mailing Address - State:CA
Mailing Address - Zip Code:92586-2282
Mailing Address - Country:US
Mailing Address - Phone:951-821-6312
Mailing Address - Fax:
Practice Address - Street 1:27851 BRADLEY RD STE 130L
Practice Address - Street 2:
Practice Address - City:MENIFEE
Practice Address - State:CA
Practice Address - Zip Code:92586-2282
Practice Address - Country:US
Practice Address - Phone:951-821-6312
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-06
Last Update Date:2021-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty