Provider Demographics
NPI:1952575631
Name:COURAGE TO CHANGE - A MARRIAGE AND FAMILY COUNSELING CORPORTATION
Entity type:Organization
Organization Name:COURAGE TO CHANGE - A MARRIAGE AND FAMILY COUNSELING CORPORTATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST, PRINCIPAL
Authorized Official - Prefix:DR
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:R
Authorized Official - Last Name:ZEMANSKY
Authorized Official - Suffix:
Authorized Official - Credentials:PSY
Authorized Official - Phone:310-664-0454
Mailing Address - Street 1:3331 OCEAN PARK BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90405-3216
Mailing Address - Country:US
Mailing Address - Phone:310-664-0454
Mailing Address - Fax:310-553-8743
Practice Address - Street 1:3331 OCEAN PARK BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90405-3216
Practice Address - Country:US
Practice Address - Phone:310-664-0454
Practice Address - Fax:310-553-8743
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-15
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY21760103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty