Healthcare Provider Details

I. General information

NPI: 1255981544
Provider Name (Legal Business Name): GATHER AND GROW MARRIAGE AND FAMILY THERAPY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2019
Last Update Date: 09/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 E CHAPMAN AVE
FULLERTON CA
92831-3803
US

IV. Provider business mailing address

601 E CHAPMAN AVE
FULLERTON CA
92831-3803
US

V. Phone/Fax

Practice location:
  • Phone: 714-600-9762
  • Fax:
Mailing address:
  • Phone: 714-600-9762
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: JACQUELINE PLANTE
Title or Position: CEO
Credential:
Phone: 714-403-6421