Provider Demographics
NPI:1629805676
Name:PETRICHOR HEALING FAMILY THERAPY, INC.
Entity type:Organization
Organization Name:PETRICHOR HEALING FAMILY THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:A
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:562-535-3102
Mailing Address - Street 1:10650 REAGAN ST UNIT 648
Mailing Address - Street 2:
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-8834
Mailing Address - Country:US
Mailing Address - Phone:562-535-3102
Mailing Address - Fax:
Practice Address - Street 1:10650 REAGAN ST UNIT 648
Practice Address - Street 2:
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-8834
Practice Address - Country:US
Practice Address - Phone:562-535-3102
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-16
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty