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General NPI Number Information
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NPI Number | 1699595249
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Entity Type | Organization
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Legal Business Name | MB MARRIAGE AND FAMILY THERAPY CORPORATION
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Dates
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Enumeration Date | 10/16/2024
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Last Update Date | 10/16/2024
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Provider Practice Location Address
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Address Line | 3231 OCEAN PARK BLVD STE 122
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City | SANTA MONICA
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State | CA
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Zip | 90405-3231
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Country | US
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Telephone | 310-626-4789
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Fax |
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Provider Business Mailing Address
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Address Line | 640 WOODLAWN AVE
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City | VENICE
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State | CA
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Zip | 90291-4851
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Country | US
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Telephone | 310-626-4789
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MARY BARBOUR
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Credential | LMFT
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Telephone | 323-445-5765
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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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