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General NPI Number Information
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NPI Number | 1164883880
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Entity Type | Organization
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Legal Business Name | RANDY CHRISTOPHER
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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 | 482 N ROSEMEAD BLVD SUITE 103
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City | PASADENA
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State | CA
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Zip | 91107-3000
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Country | US
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Telephone | 626-701-4249
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Fax |
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Provider Business Mailing Address
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Address Line | 482 N ROSEMEAD BLVD SUITE 103
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City | PASADENA
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State | CA
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Zip | 91107-3000
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Country | US
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Telephone | 626-701-4249
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Fax |
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Authorized Official
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Title or Position | CEO / DIRECTOR
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Name | MRS. WENDY L SELEVITCH
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Credential | PHD
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Telephone | 626-701-4249
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 37646
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License Number State | CA
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