Healthcare Provider Details

I. General information

NPI: 1093250995
Provider Name (Legal Business Name): BREATHE FAMILY COUNSELING AND WELLNESS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/31/2016
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 CONTINENTAL BLVD STE 120
EL SEGUNDO CA
90245-4513
US

IV. Provider business mailing address

200 E MAPLE AVE
EL SEGUNDO CA
90245-2330
US

V. Phone/Fax

Practice location:
  • Phone: 310-251-4170
  • Fax:
Mailing address:
  • Phone: 310-872-8183
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: PAIGE G PARKER
Title or Position: PRESIDENT
Credential: DR
Phone: 310-251-4170