Provider Demographics
NPI:1356721559
Name:FAMILY MATTERS COUNSELING CENTER, INC.
Entity type:Organization
Organization Name:FAMILY MATTERS COUNSELING CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:S
Authorized Official - Last Name:DEPAOLA
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:714-932-9641
Mailing Address - Street 1:746 E CHAPMAN AVE
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92866-1621
Mailing Address - Country:US
Mailing Address - Phone:714-932-9641
Mailing Address - Fax:
Practice Address - Street 1:746 E CHAPMAN AVE
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92866-1621
Practice Address - Country:US
Practice Address - Phone:714-932-9641
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-02
Last Update Date:2015-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC40001251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1750636874Medicaid
CA1750636874OtherBLUE SHIELD OF CALIFORNIA
CA1750636874OtherVALUE OPTIONS