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General NPI Number Information
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NPI Number | 1619775681
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Entity Type | Organization
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Legal Business Name | VINE MARRIAGE & FAMILY THERAPY INC
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Dates
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Enumeration Date | 03/05/2025
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Last Update Date | 03/05/2025
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Provider Practice Location Address
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Address Line | 265 S RANDOLPH AVE STE 185
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City | BREA
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State | CA
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Zip | 92821-5702
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Country | US
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Telephone | 657-377-5522
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Fax |
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Provider Business Mailing Address
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Address Line | 3813 CROMWELL DR
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City | CARROLLTON
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State | TX
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Zip | 75007-2852
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Country | US
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Telephone | 657-377-5522
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Fax |
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Authorized Official
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Title or Position | MARRIAGE & FAMILY THERAPIST
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Name | EUI KIM
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Credential |
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Telephone | 812-994-0046
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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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