Provider Demographics
NPI:1700409638
Name:URAM FAMILY THERAPY PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:URAM FAMILY THERAPY PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:URAM
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LMFT, LPCC
Authorized Official - Phone:949-777-6694
Mailing Address - Street 1:1000 QUAIL ST STE 155
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-2765
Mailing Address - Country:US
Mailing Address - Phone:949-777-6694
Mailing Address - Fax:949-242-2222
Practice Address - Street 1:1000 QUAIL ST STE 155
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-2765
Practice Address - Country:US
Practice Address - Phone:949-777-6694
Practice Address - Fax:949-242-2222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-27
Last Update Date:2020-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty