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General NPI Number Information
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NPI Number | 1407570278
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Entity Type | Organization
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Legal Business Name | ADVANTAGE MENTAL HEALTH AND MARRIAGE COUNSELING INC.
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Dates
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Enumeration Date | 09/26/2022
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Last Update Date | 10/09/2024
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Provider Practice Location Address
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Address Line | 1430 BLUE OAKS BLVD STE 120
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City | ROSEVILLE
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State | CA
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Zip | 95747-5156
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Country | US
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Telephone | 805-478-1776
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Fax |
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Provider Business Mailing Address
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Address Line | 9025 QUARTET AVE
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City | ROSEVILLE
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State | CA
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Zip | 95747-8644
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Country | US
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Telephone | 805-478-1776
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MASON ANGLIN
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Credential | LMFT
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Telephone | 805-478-1776
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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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