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General NPI Number Information
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NPI Number | 1780167254
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Entity Type | Organization
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Legal Business Name | CHILD PARENT CONNECTION, A FAMILY THERAPY CORPORATION
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Dates
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Enumeration Date | 09/11/2018
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Last Update Date | 09/11/2018
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Provider Practice Location Address
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Address Line | 1801 S CATALINA AVE STE 306
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City | REDONDO BEACH
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State | CA
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Zip | 90277-5513
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Country | US
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Telephone | 424-216-9600
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Fax |
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Provider Business Mailing Address
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Address Line | 1801 S CATALINA AVE STE 306
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City | REDONDO BEACH
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State | CA
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Zip | 90277-5513
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Country | US
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Telephone | 424-216-9600
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Fax |
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Authorized Official
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Title or Position | OWNER/DIRECTOR
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Name | MRS. BRYANA ROCHELLE KAPPDAKUNNEL
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Credential | LMFT, IFECMHS
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Telephone | 424-216-9600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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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 |
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License Number State |
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