Healthcare Provider Details

I. General information

NPI: 1063751303
Provider Name (Legal Business Name): CROSS CULTURAL MARRIAGE AND FAMILYTHERAPY COUNSELLING CE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2013
Last Update Date: 05/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

535 W STATE ST SUITE # C
REDLANDS CA
92373-4662
US

IV. Provider business mailing address

PO BOX 10908
SAN BERNARDINO CA
92423-0908
US

V. Phone/Fax

Practice location:
  • Phone: 562-522-8008
  • Fax: 909-335-5991
Mailing address:
  • Phone: 562-522-8008
  • Fax: 909-335-5991

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. BETTY B.A. ODAK
Title or Position: CLINICAL DIRECTOR
Credential: LMFT
Phone: 562-522-8008