Provider Demographics
NPI:1790326437
Name:SELF DISCOVERY MARRIAGE COUNSELING PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:SELF DISCOVERY MARRIAGE COUNSELING PROFESSIONAL CORPORATION
Other - Org Name:SELF DISCOVERY COUNSELING SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/ PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:
Authorized Official - Last Name:BENITEZ
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:562-270-2198
Mailing Address - Street 1:7032 COMSTOCK AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90602-1390
Mailing Address - Country:US
Mailing Address - Phone:562-270-2198
Mailing Address - Fax:562-457-3513
Practice Address - Street 1:7032 COMSTOCK AVE STE 201
Practice Address - Street 2:
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90602-1390
Practice Address - Country:US
Practice Address - Phone:562-270-2198
Practice Address - Fax:562-693-3380
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-03
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty