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General NPI Number Information
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NPI Number | 1538431168
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Entity Type | Organization
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Legal Business Name | WAYPOINT MARRIAGE THERAPY CENTER PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 01/27/2012
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Last Update Date | 01/27/2012
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Provider Practice Location Address
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Address Line | 595 E COLORADO BLVD STE 9
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City | PASADENA
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State | CA
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Zip | 91101-2039
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Country | US
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Telephone | 626-449-1419
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Fax | 626-644-9141
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Provider Business Mailing Address
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Address Line | 595 E COLORADO BLVD STE 9
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City | PASADENA
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State | CA
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Zip | 91101-2039
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Country | US
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Telephone | 626-449-1419
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Fax | 626-644-9141
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Authorized Official
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Title or Position | PRESIDENT
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Name | RICHARD RUPP
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Credential | MFT
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Telephone | 626-449-1419
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number | MFC25812
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License Number State | CA
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