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General NPI Number Information
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NPI Number | 1023861572
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Entity Type | Organization
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Legal Business Name | HER SPACE THERAPY, A MARRIAGE AND FAMILY CORPORATION
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Dates
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Enumeration Date | 04/05/2024
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Last Update Date | 04/05/2024
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Provider Practice Location Address
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Address Line | 107 S FAIR OAKS AVE STE 310
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City | PASADENA
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State | CA
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Zip | 91105-2012
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Country | US
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Telephone | 626-681-3283
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Fax |
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Provider Business Mailing Address
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Address Line | 1680 LAS FLORES AVE
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City | SAN MARINO
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State | CA
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Zip | 91108-1614
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CYLA G FISK
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Credential | LMFT
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Telephone | 626-681-3283
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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