Provider Demographics
NPI:1831880954
Name:POPPY PEAK INDIVIDUAL AND FAMILY THERAPY, INC.
Entity type:Organization
Organization Name:POPPY PEAK INDIVIDUAL AND FAMILY THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:BARTEK
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:626-790-8221
Mailing Address - Street 1:1510 OXLEY ST STE J
Mailing Address - Street 2:
Mailing Address - City:SOUTH PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91030-5748
Mailing Address - Country:US
Mailing Address - Phone:626-790-8221
Mailing Address - Fax:
Practice Address - Street 1:1510 OXLEY ST STE J
Practice Address - Street 2:
Practice Address - City:SOUTH PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91030-5748
Practice Address - Country:US
Practice Address - Phone:626-790-8221
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-18
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty