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General NPI Number Information
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NPI Number | 1558099556
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Entity Type | Organization
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Legal Business Name | CREATING BEAUTIFUL MINDS FAMILY THERAPY INC.
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Dates
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Enumeration Date | 08/09/2022
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Last Update Date | 08/09/2022
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Provider Practice Location Address
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Address Line | 12304 SANTA MONICA BLVD STE 212
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City | LOS ANGELES
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State | CA
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Zip | 90025-2587
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Country | US
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Telephone | 310-463-7122
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 362
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City | SANTA MONICA
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State | CA
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Zip | 90406-0362
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Country | US
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Telephone | 310-463-7112
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ANGELA L MULL
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Credential | LMFT
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Telephone | 310-463-7122
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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