Healthcare Provider Details

I. General information

NPI: 1649537234
Provider Name (Legal Business Name): SYNC COUNSELING CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2012
Last Update Date: 04/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

482 N ROSEMEAD BLVD SUITE 207
PASADENA CA
91107-3053
US

IV. Provider business mailing address

482 N ROSEMEAD BLVD SUITE 207
PASADENA CA
91107-3053
US

V. Phone/Fax

Practice location:
  • Phone: 626-802-5490
  • Fax: 626-466-1199
Mailing address:
  • Phone: 626-802-5490
  • Fax: 626-466-1199

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License NumberMFT31636
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFT31636
License Number StateCA

VIII. Authorized Official

Name: DR. CURTIS MILLER
Title or Position: EXECUTIVE DIRECTOR
Credential: PSY.D, MFT 31636
Phone: 626-802-5493