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General NPI Number Information
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NPI Number | 1811620412
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Entity Type | Organization
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Legal Business Name | COLOR ME WELL MARRIAGE AND FAMILY THERAPY
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Dates
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Enumeration Date | 07/01/2022
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Last Update Date | 07/01/2022
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Provider Practice Location Address
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Address Line | 350 S LAKE AVE STE 282
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City | PASADENA
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State | CA
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Zip | 91101-3562
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Country | US
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Telephone | 213-300-3997
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Fax |
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Provider Business Mailing Address
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Address Line | 4555 FULTON AVE APT 214
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City | SHERMAN OAKS
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State | CA
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Zip | 91423-3202
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Country | US
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Telephone | 213-300-3997
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | TIFFANY O'BANNON
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Credential |
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Telephone | 213-300-3997
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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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