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General NPI Number Information
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NPI Number | 1508344235
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Entity Type | Organization
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Legal Business Name | DIALOGS WITH LIFE A MEDICAL CORPORATION
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Dates
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Enumeration Date | 08/03/2018
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Last Update Date | 08/03/2018
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Provider Practice Location Address
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Address Line | 1055 E COLORADO BLVD STE 5190
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City | PASADENA
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State | CA
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Zip | 91106-2327
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Country | US
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Telephone | 213-373-1938
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Fax | 213-226-0556
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Provider Business Mailing Address
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Address Line | 465 S HUDSON AVE APT 1
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City | PASADENA
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State | CA
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Zip | 91101-5007
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Country | US
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Telephone | 213-373-1938
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Fax | 213-226-0556
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. BERNARD MARTIN DOUGLAS
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Credential | LMFT
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Telephone | 213-373-1938
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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 | 102496
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License Number State | CA
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