Healthcare Provider Details

I. General information

NPI: 1518632249
Provider Name (Legal Business Name): COMPLETE FAMILY THERAPY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2021
Last Update Date: 08/13/2021
Certification Date: 08/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2030 E 4TH ST STE 138F
SANTA ANA CA
92705-3920
US

IV. Provider business mailing address

2030 E 4TH ST STE 138F
SANTA ANA CA
92705-3920
US

V. Phone/Fax

Practice location:
  • Phone: 657-232-0304
  • Fax: 657-232-1065
Mailing address:
  • Phone: 657-232-0304
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MRS. JANET M FRANCIS-CISNEROS
Title or Position: PRESIDENT & CEO
Credential: LMFT
Phone: 657-236-4411