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General NPI Number Information
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NPI Number | 1790271716
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Entity Type | Organization
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Legal Business Name | THE NORTH STAR CENTER FOR MARRIAGE AND FAMILY THERAPY, INC.
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Dates
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Enumeration Date | 07/02/2018
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Last Update Date | 04/01/2021
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Provider Practice Location Address
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Address Line | FAITH RECOVERY 2211 SUITE C PALO VERDE AVE
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City | LONG BEACH
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State | CA
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Zip | 90815
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Country | US
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Telephone | 310-770-2744
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 880
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City | SEAL BEACH
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State | CA
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Zip | 90740-0880
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Country | US
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Telephone | 310-770-2744
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JEMMA CANNON
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Credential |
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Telephone | 310-770-2744
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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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 | 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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