Provider Demographics
NPI:1891386546
Name:CHARLYN CRANE ERDEK MARRIAGE AND FAMILY THERAPY CORPORATION
Entity Type:Organization
Organization Name:CHARLYN CRANE ERDEK MARRIAGE AND FAMILY THERAPY CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHARLYN
Authorized Official - Middle Name:C
Authorized Official - Last Name:ERDEK
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT, ATR
Authorized Official - Phone:213-359-7053
Mailing Address - Street 1:PO BOX 10641
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91510-0641
Mailing Address - Country:US
Mailing Address - Phone:213-359-7053
Mailing Address - Fax:213-348-6106
Practice Address - Street 1:5900 WEDGEWOOD AVE
Practice Address - Street 2:
Practice Address - City:CARMICHAEL
Practice Address - State:CA
Practice Address - Zip Code:95608-5238
Practice Address - Country:US
Practice Address - Phone:213-279-6447
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-26
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty