Provider Demographics
NPI:1770125601
Name:PROSPECT FAMILY THERAPY, A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:PROSPECT FAMILY THERAPY, A PROFESSIONAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SARA
Authorized Official - Middle Name:
Authorized Official - Last Name:STANIZAI
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:562-704-4736
Mailing Address - Street 1:4510 E PACIFIC COAST HWY STE 540
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90804-6941
Mailing Address - Country:US
Mailing Address - Phone:562-704-4736
Mailing Address - Fax:
Practice Address - Street 1:4510 E PACIFIC COAST HWY STE 540
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90804-6941
Practice Address - Country:US
Practice Address - Phone:562-704-4736
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-11
Last Update Date:2024-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty