Provider Demographics
NPI:1871244459
Name:MD MARRIAGE FAMILY THERAPISTS, INC.
Entity Type:Organization
Organization Name:MD MARRIAGE FAMILY THERAPISTS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:DANN-MCNAMEE
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:626-863-3393
Mailing Address - Street 1:1340 E ROUTE 66 STE 108
Mailing Address - Street 2:
Mailing Address - City:GLENDORA
Mailing Address - State:CA
Mailing Address - Zip Code:91740-3783
Mailing Address - Country:US
Mailing Address - Phone:626-863-3393
Mailing Address - Fax:909-599-7567
Practice Address - Street 1:1340 E ROUTE 66 STE 108
Practice Address - Street 2:
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91740-3783
Practice Address - Country:US
Practice Address - Phone:626-863-3393
Practice Address - Fax:909-599-7567
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-14
Last Update Date:2022-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty