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General NPI Number Information
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NPI Number | 1093281990
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Entity Type | Organization
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Legal Business Name | THROUGH THE SEA MARRIAGE AND FAMILY COUNSELING INC
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Dates
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Enumeration Date | 10/17/2018
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Last Update Date | 12/27/2022
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Provider Practice Location Address
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Address Line | 2155 E GARVEY AVE N STE B17
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City | WEST COVINA
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State | CA
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Zip | 91791-1545
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Country | US
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Telephone | 626-489-9144
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Fax |
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Provider Business Mailing Address
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Address Line | 2155 E GARVEY AVE N STE B17
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City | WEST COVINA
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State | CA
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Zip | 91791-1545
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Country | US
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Telephone | 626-489-9144
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | SAMANTHA M PANE
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Credential | LMFT
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Telephone | 714-798-1958
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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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 |
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