Provider Demographics
NPI:1669100301
Name:E.L. FOROUTAN MARRIAGE AND FAMILY THERAPY INC.
Entity type:Organization
Organization Name:E.L. FOROUTAN MARRIAGE AND FAMILY THERAPY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:ERIKA
Authorized Official - Middle Name:LAUREN
Authorized Official - Last Name:FOROUTAN
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:213-538-2790
Mailing Address - Street 1:6121 1/2 GLEN HOLLY ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90068-2301
Mailing Address - Country:US
Mailing Address - Phone:562-619-2400
Mailing Address - Fax:
Practice Address - Street 1:2656 29TH ST STE 208
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90405-2947
Practice Address - Country:US
Practice Address - Phone:213-538-2790
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-10
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty