Healthcare Provider Details

I. General information

NPI: 1407769326
Provider Name (Legal Business Name): HOPE COLLABORATIVE THERAPY GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2026
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9140 BROOKSHIRE AVE APT 202
DOWNEY CA
90240-2963
US

IV. Provider business mailing address

9140 BROOKSHIRE AVE APT 202
DOWNEY CA
90240-2963
US

V. Phone/Fax

Practice location:
  • Phone: 626-798-6793
  • Fax:
Mailing address:
  • Phone:
  • 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: SAMUEL WILSON
Title or Position: OWNER
Credential:
Phone: 626-798-6793