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General NPI Number Information
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NPI Number | 1316762339
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Entity Type | Organization
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Legal Business Name | KAIZEN CONSCIOUS LIVING & FAMILY THERAPY, PROFESSION CORPORATION
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Dates
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Enumeration Date | 11/15/2024
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Last Update Date | 11/15/2024
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Provider Practice Location Address
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Address Line | 23120 ALICIA PKWY STE 200
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City | MISSION VIEJO
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State | CA
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Zip | 92692-1212
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Country | US
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Telephone | 949-306-1772
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Fax |
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Provider Business Mailing Address
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Address Line | 33742 ALCAZAR DR APT A
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City | DANA POINT
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State | CA
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Zip | 92629-6402
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Country | US
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Telephone | 949-310-8417
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | KIMBERLY J CRAVOTTA-PURVIS
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Credential | LMFT
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Telephone | 949-310-8417
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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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