Healthcare Provider Details

I. General information

NPI: 1760139455
Provider Name (Legal Business Name): MORANT MARRIAGE AND FAMILY THERAPY PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2022
Last Update Date: 03/03/2022
Certification Date: 03/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 E OCEAN BLVD UNIT 509
LONG BEACH CA
90802-5450
US

IV. Provider business mailing address

PO BOX 756
LONG BEACH CA
90801-0756
US

V. Phone/Fax

Practice location:
  • Phone: 562-294-5707
  • Fax:
Mailing address:
  • Phone: 562-294-5707
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: JOCELYN MORRIS-BRYANT
Title or Position: OWNER/THERAPIST
Credential: LMFT
Phone: 562-294-5707