Healthcare Provider Details

I. General information

NPI: 1790614071
Provider Name (Legal Business Name): KEITH LAWRENCE MARRIAGE AND FAMILY THERAPIST PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2026
Last Update Date: 05/14/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5150 E PACIFIC COAST HWY FL 2
LONG BEACH CA
90804-3399
US

IV. Provider business mailing address

5150 E PACIFIC COAST HWY FL 2
LONG BEACH CA
90804-3399
US

V. Phone/Fax

Practice location:
  • Phone: 562-743-3117
  • Fax:
Mailing address:
  • Phone: 562-743-3117
  • 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: KEITH LAWRENCE
Title or Position: THERAPIST
Credential: LMFT
Phone: 562-743-3117