MEDICARE: SOFT CLAY MARRIAGE FAMILY THERAPY, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	MFCC42686	CA

General Provider Information

NPI Number	:	1518234251
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOFT CLAY MARRIAGE FAMILY THERAPY, INC.

Provider Business Mailing Address
First Line	:	18000 STUDEBAKER RD.
Second Line	:	STE. 700
City	:	CERRITOS
State	:	CA
Zip	:	90703-2684
Country	:	US
Telephone Number	:	562-467-8958
Fax Number	:	562-467-8959

Provider Business Practice Location Address
First Line	:	18000 STUDEBAKER RD STE 700
Second Line	:
City	:	CERRITOS
State	:	CA
Zip	:	90703-2684
Country	:	US
Telephone Number	:	562-467-8958
Fax Number	:	562-467-8959

Authorized Official
Title or Position	:	LMFT, OWNER
Name	:	MRS. KIMBERLY ANN NAVARRO
Credential	:	M.S.
Telephone Number	:	562-467-8958

Provider Enumeration Date	:	11/23/2011
Last Update Date	:	11/23/2011

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