Healthcare Provider Details

I. General information

NPI: 1457422552
Provider Name (Legal Business Name): ASSOCIATED CHRISTIAN THERAPY SERVICES A MARRIAGE FAMILY & CHILD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/11/2006
Last Update Date: 10/12/2022
Certification Date: 10/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41765 12TH ST W STE D
PALMDALE CA
93551-1422
US

IV. Provider business mailing address

41765 12TH ST W STE D
PALMDALE CA
93551-1422
US

V. Phone/Fax

Practice location:
  • Phone: 661-940-4861
  • Fax: 661-942-4511
Mailing address:
  • Phone: 661-940-4861
  • Fax: 661-942-4511

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 Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC 27410
License Number StateCA

VIII. Authorized Official

Name: RICHARD OLSON
Title or Position: OWNER
Credential: MFT
Phone: 661-940-4861