Provider Demographics
NPI:1396580338
Name:MENTAL WEALTH AMBITION - A MARRIAGE FAMILY AND CHILD THERAPY PROFESSIO
Entity type:Organization
Organization Name:MENTAL WEALTH AMBITION - A MARRIAGE FAMILY AND CHILD THERAPY PROFESSIO
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:GEHLKE NOLAN
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD, LMFT
Authorized Official - Phone:714-943-6922
Mailing Address - Street 1:5942 EDINGER AVE STE 113
Mailing Address - Street 2:PMB 238
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92649
Mailing Address - Country:US
Mailing Address - Phone:714-943-6922
Mailing Address - Fax:
Practice Address - Street 1:6512 OXFORD DR
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92647-2642
Practice Address - Country:US
Practice Address - Phone:714-943-6922
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-01
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty