Provider Demographics
NPI:1962173815
Name:THE HAPPY MARRIAGE & FAMILY THERAPIST INCORPORTATED
Entity type:Organization
Organization Name:THE HAPPY MARRIAGE & FAMILY THERAPIST INCORPORTATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JANISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:MICKENS
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:310-598-8048
Mailing Address - Street 1:1225 W 190TH ST STE 455H
Mailing Address - Street 2:
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90248-4320
Mailing Address - Country:US
Mailing Address - Phone:310-598-8048
Mailing Address - Fax:
Practice Address - Street 1:1225 W 190TH ST STE 455H
Practice Address - Street 2:
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90248-4320
Practice Address - Country:US
Practice Address - Phone:310-598-8048
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-21
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)