Healthcare Provider Details

I. General information

NPI: 1740055417
Provider Name (Legal Business Name): VALENCIA RELATIONSHIP INSTITUTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2023
Last Update Date: 02/06/2024
Certification Date: 02/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2136 CUTLER ST
SIMI VALLEY CA
93065-4923
US

IV. Provider business mailing address

28494 WESTINGHOUSE PL STE 213
VALENCIA CA
91355-0934
US

V. Phone/Fax

Practice location:
  • Phone: 818-626-4097
  • 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: JOSEPH MORAN
Title or Position: AMFT
Credential:
Phone: 818-626-4097