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General NPI Number Information
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NPI Number | 1013719939
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Entity Type | Organization
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Legal Business Name | MESH FAMILY THERAPY COLLECTIVE, INC.
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Dates
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Enumeration Date | 03/24/2025
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Last Update Date | 03/24/2025
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Provider Practice Location Address
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Address Line | 1150 S ROBERTSON BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90035-1404
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Country | US
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Telephone | 424-333-4551
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Fax |
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Provider Business Mailing Address
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Address Line | 1155 S WINDSOR BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90019-3158
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Country | US
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Telephone | 858-736-7003
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Fax | 858-736-7003
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Authorized Official
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Title or Position | OWNER/CLINICAL DIRECTOR
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Name | EMILY WAITT
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Credential | MFT
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Telephone | 858-736-7003
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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