Healthcare Provider Details

I. General information

NPI: 1730712761
Provider Name (Legal Business Name): CREATING CHANGE LA, INDIVIDUAL & COUPLE MARRIAGE COUNSELING & SEX THER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/18/2020
Last Update Date: 02/18/2020
Certification Date: 02/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

337 S BEVERLY DR STE 201
BEVERLY HILLS CA
90212-4308
US

IV. Provider business mailing address

337 S BEVERLY DR STE 201
BEVERLY HILLS CA
90212-4308
US

V. Phone/Fax

Practice location:
  • Phone: 310-963-4216
  • Fax:
Mailing address:
  • Phone: 310-963-4216
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: NATALIE FINEGOOD GOLDBERG
Title or Position: OWNER
Credential:
Phone: 310-963-4216