Healthcare Provider Details

I. General information

NPI: 1780167254
Provider Name (Legal Business Name): CHILD PARENT CONNECTION, A FAMILY THERAPY CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2018
Last Update Date: 09/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 S CATALINA AVE STE 306
REDONDO BEACH CA
90277-5513
US

IV. Provider business mailing address

1801 S CATALINA AVE STE 306
REDONDO BEACH CA
90277-5513
US

V. Phone/Fax

Practice location:
  • Phone: 424-216-9600
  • Fax:
Mailing address:
  • Phone: 424-216-9600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MRS. BRYANA ROCHELLE KAPPDAKUNNEL
Title or Position: OWNER/DIRECTOR
Credential: LMFT, IFECMHS
Phone: 424-216-9600