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General NPI Number Information
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NPI Number | 1447511084
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Entity Type | Organization
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Legal Business Name | ARTEMIS CENTER FOR FAMILY, A PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 05/30/2012
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Last Update Date | 05/30/2012
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Provider Practice Location Address
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Address Line | 815 S AVERILL AVE
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City | SAN PEDRO
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State | CA
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Zip | 90732-3815
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Country | US
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Telephone | 310-809-2011
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Fax | 310-832-0862
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Provider Business Mailing Address
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Address Line | 1621 W. 25TH STREET, #221
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City | SAN PEDRO
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State | CALIFORNIA
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Zip | 90732
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Country | UM
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Telephone | 310-809-2011
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Fax | 310-832-0862
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Authorized Official
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Title or Position | OWNER/CFO
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Name | MRS. ARTEMIS TEGAN
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Credential | MFC
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Telephone | 310-809-2011
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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 | 42001
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License Number State | CA
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