Healthcare Provider Details

I. General information

NPI: 1992654636
Provider Name (Legal Business Name): PHAMILY MARRIAGE AND FAMILY THERAPY PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2026
Last Update Date: 01/26/2026
Certification Date: 01/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 N SANTA ANITA AVE STE 800
ARCADIA CA
91006-3129
US

IV. Provider business mailing address

150 N SANTA ANITA AVE STE 800
ARCADIA CA
91006-3129
US

V. Phone/Fax

Practice location:
  • Phone: 626-604-6240
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: MS. TINA PHAM
Title or Position: CEO/DIRECTOR
Credential: LMFT, LPCC
Phone: 626-604-6240