Provider Demographics
NPI:1932608841
Name:PARENT CHILD CLINIC INC
Entity Type:Organization
Organization Name:PARENT CHILD CLINIC INC
Other - Org Name:PARENT CHILD THERAPY CLINIC INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:STUART
Authorized Official - Last Name:KELLY
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:805-625-2244
Mailing Address - Street 1:260 MAPLE CT STE 265
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-3572
Mailing Address - Country:US
Mailing Address - Phone:805-625-2244
Mailing Address - Fax:844-528-1796
Practice Address - Street 1:260 MAPLE CT STE 265
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-3572
Practice Address - Country:US
Practice Address - Phone:805-625-2244
Practice Address - Fax:844-528-1796
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-06
Last Update Date:2020-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA42983106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty