Provider Demographics
NPI:1770048951
Name:MARIO PALACIOS THERAPY
Entity type:Organization
Organization Name:MARIO PALACIOS THERAPY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:LMFT
Authorized Official - Prefix:MR
Authorized Official - First Name:MARIO
Authorized Official - Middle Name:FERNANDO
Authorized Official - Last Name:PALACIOS
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:310-384-3922
Mailing Address - Street 1:3824 MOTOR AVE APT 21
Mailing Address - Street 2:
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90232-3156
Mailing Address - Country:US
Mailing Address - Phone:310-384-3922
Mailing Address - Fax:
Practice Address - Street 1:5556 S CENTINELA AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90066-6912
Practice Address - Country:US
Practice Address - Phone:310-384-3922
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-01
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty