Healthcare Provider Details

I. General information

NPI: 1346986528
Provider Name (Legal Business Name): MARRIAGE & FAMILY THERAPY WITH ASAL LARRY AND ASSOCIATES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2022
Last Update Date: 03/06/2023
Certification Date: 03/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 DOVE ST STE 335
NEWPORT BEACH CA
92660-1433
US

IV. Provider business mailing address

28241 CROWN VALLEY PKWY # F306
LAGUNA NIGUEL CA
92677-4441
US

V. Phone/Fax

Practice location:
  • Phone: 949-395-8246
  • Fax: 760-859-3877
Mailing address:
  • Phone: 949-395-8246
  • 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: ASAL LARRY
Title or Position: OWNER
Credential: LMFT
Phone: 949-395-8246