Healthcare Provider Details

I. General information

NPI: 1588018568
Provider Name (Legal Business Name): TOGETHER FAMILY THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2016
Last Update Date: 04/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

260 MAPLE CT
VENTURA CA
93003-3516
US

IV. Provider business mailing address

390 WALNUT DR
VENTURA CA
93003-2054
US

V. Phone/Fax

Practice location:
  • Phone: 805-302-5335
  • Fax:
Mailing address:
  • Phone: 805-216-2369
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberIMF84550
License Number StateCA

VIII. Authorized Official

Name: MS. DIANA WIGHTMAN
Title or Position: OWNER
Credential: LMFT
Phone: 805-302-5335