Healthcare Provider Details

I. General information

NPI: 1578397311
Provider Name (Legal Business Name): CHELSEA FOMIN, LMFT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2024
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

595 E COLORADO BLVD STE 205
PASADENA CA
91101-2028
US

IV. Provider business mailing address

595 E COLORADO BLVD STE 205
PASADENA CA
91101-2028
US

V. Phone/Fax

Practice location:
  • Phone: 323-536-2203
  • Fax:
Mailing address:
  • Phone:
  • 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: CHELSEA FOMIN
Title or Position: LMFT
Credential: LMFT
Phone: 323-536-2203