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General NPI Number Information
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NPI Number | 1043671845
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Entity Type | Organization
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Legal Business Name | INDIVIDUAL, COUPLES AND FAMILY THERAPY INC.
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Dates
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Enumeration Date | 03/08/2016
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Last Update Date | 03/08/2016
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Provider Practice Location Address
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Address Line | 10811 WASHINGTON BLVD STE 301
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City | CULVER CITY
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State | CA
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Zip | 90232-3666
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Country | US
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Telephone | 310-431-7532
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Fax |
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Provider Business Mailing Address
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Address Line | 10811 WASHINGTON BLVD STE 301
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City | CULVER CITY
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State | CA
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Zip | 90232-3666
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Country | US
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Telephone | 310-431-7532
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | CAITLIN TONDA
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Credential | MFT
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Telephone | 310-431-7532
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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 | MFC49377
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License Number State | CA
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