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General NPI Number Information
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NPI Number | 1063751303
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Entity Type | Organization
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Legal Business Name | CROSS CULTURAL MARRIAGE AND FAMILYTHERAPY COUNSELLING CE
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Dates
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Enumeration Date | 02/06/2013
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Last Update Date | 05/03/2013
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Provider Practice Location Address
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Address Line | 535 W STATE ST SUITE # C
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City | REDLANDS
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State | CA
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Zip | 92373-4662
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Country | US
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Telephone | 562-522-8008
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Fax | 909-335-5991
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Provider Business Mailing Address
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Address Line | PO BOX 10908
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City | SAN BERNARDINO
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State | CA
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Zip | 92423-0908
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Country | US
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Telephone | 562-522-8008
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Fax | 909-335-5991
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | MS. BETTY B.A. ODAK
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Credential | LMFT
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Telephone | 562-522-8008
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State | CA
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