Provider Demographics
NPI:1659112381
Name:A SAFE SPACE INDIVIDUAL FAMILY AND MARRIAGE TELEHEALTH COUNSELING
Entity type:Organization
Organization Name:A SAFE SPACE INDIVIDUAL FAMILY AND MARRIAGE TELEHEALTH COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LMFT
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHERRY
Authorized Official - Middle Name:M
Authorized Official - Last Name:MORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-966-7893
Mailing Address - Street 1:27890 CLINTON KEITH ROAD
Mailing Address - Street 2:SUITE D #167
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92562-8572
Mailing Address - Country:US
Mailing Address - Phone:951-966-7893
Mailing Address - Fax:
Practice Address - Street 1:30914 PALETTE RD
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92563-1185
Practice Address - Country:US
Practice Address - Phone:951-966-7893
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-05
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty