Provider Demographics
NPI:1912034216
Name:WANT INSTITUTE
Entity Type:Organization
Organization Name:WANT INSTITUTE
Other - Org Name:FOR MARRIAGE FAMILY AND CHILD COUNSELING
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR FOR MARRIAGE FAMILY AND CH
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:DIANNE
Authorized Official - Last Name:ALLEN SHANAHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MFT 6801
Authorized Official - Phone:949-723-0338
Mailing Address - Street 1:3355 VIA LIDO
Mailing Address - Street 2:# 205
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663-3960
Mailing Address - Country:US
Mailing Address - Phone:949-723-0338
Mailing Address - Fax:949-458-0904
Practice Address - Street 1:3355 VIA LIDO
Practice Address - Street 2:# 205
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663
Practice Address - Country:US
Practice Address - Phone:949-723-0338
Practice Address - Fax:949-458-0904
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6801106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty