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General NPI Number Information
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NPI Number | 1174401236
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Entity Type | Organization
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Legal Business Name | TIDE AND SHORE MARRIAGE AND FAMILY THERAPY
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Dates
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Enumeration Date | 08/25/2025
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Last Update Date | 08/25/2025
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Provider Practice Location Address
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Address Line | 516 PENNSFIELD PL STE 208
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City | THOUSAND OAKS
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State | CA
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Zip | 91360-5530
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Country | US
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Telephone | 805-694-0251
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Fax |
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Provider Business Mailing Address
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Address Line | 2075 HIETTER AVE
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City | SIMI VALLEY
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State | CA
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Zip | 93063-2851
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Country | US
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Telephone | 805-694-0251
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KAIDI LIU
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Credential |
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Telephone | 818-606-9079
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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 |
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License Number State |
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