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General NPI Number Information
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NPI Number | 1659944361
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Entity Type | Organization
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Legal Business Name | BETH HOLDER LICENSED MARRIAGE AND FAMILY THERAPY INC
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Dates
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Enumeration Date | 07/20/2021
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Last Update Date | 07/20/2021
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Provider Practice Location Address
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Address Line | 302 N EL CAMINO REAL STE 202
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City | SAN CLEMENTE
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State | CA
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Zip | 92672-4778
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Country | US
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Telephone | 949-842-7884
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Fax | 949-272-5541
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Provider Business Mailing Address
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Address Line | 302 N EL CAMINO REAL STE 202
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City | SAN CLEMENTE
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State | CA
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Zip | 92672-4778
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Country | US
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Telephone | 949-842-7884
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Fax | 949-272-5541
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Authorized Official
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Title or Position | DIRECTOR
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Name | BETHANY HOLDER
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Credential | LMFT
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Telephone | 949-842-7884
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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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