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General NPI Number Information
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NPI Number | 1235580556
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Entity Type | Organization
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Legal Business Name | MARRIAGE MADE BETTER RELATIONSHIP COUNSELING
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Dates
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Enumeration Date | 06/28/2016
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Last Update Date | 07/20/2018
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Provider Practice Location Address
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Address Line | 30200 RANCHO VIEJO ROAD, SUITE D
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City | SAN JUAN CAPISTRANO
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State | CA
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Zip | 92675
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Country | US
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Telephone | 949-391-1812
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Fax |
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Provider Business Mailing Address
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Address Line | 47 CORTE VIDRIOSA
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City | SAN CLEMENTE
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State | CA
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Zip | 92673
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Country | US
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Telephone | 949-391-1812
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Fax |
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Authorized Official
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Title or Position | LMFT
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Name | CARLY MARIE KETCHUM
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Credential | LMFT
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Telephone | 949-391-1812
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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 | LMFT81406
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License Number State | CA
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