Provider Demographics
NPI:1891108601
Name:TINA SADRI, MA, A FAMILY & MARRIAGE THERAPY CORP
Entity Type:Organization
Organization Name:TINA SADRI, MA, A FAMILY & MARRIAGE THERAPY CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/ PROVIDER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SEYEDEH
Authorized Official - Middle Name:TINA
Authorized Official - Last Name:SADRI
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:949-283-4885
Mailing Address - Street 1:PO BOX 1534
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92659-0534
Mailing Address - Country:US
Mailing Address - Phone:949-283-4885
Mailing Address - Fax:949-502-8887
Practice Address - Street 1:351 HOSPITAL RD
Practice Address - Street 2:206
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-3509
Practice Address - Country:US
Practice Address - Phone:949-283-4885
Practice Address - Fax:949-502-8887
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-09
Last Update Date:2014-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT79583106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty