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General NPI Number Information
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NPI Number | 1851143879
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Entity Type | Organization
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Legal Business Name | THE FAMILY THERAPY CENTER CORP
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Dates
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Enumeration Date | 04/03/2024
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Last Update Date | 11/27/2024
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Provider Practice Location Address
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Address Line | 29995 TECHNOLOGY DR STE 103
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City | MURRIETA
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State | CA
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Zip | 92563-2633
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Country | US
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Telephone | 951-384-1661
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 53573
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City | RIVERSIDE
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State | CA
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Zip | 92517-4573
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO/CFO
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Name | KATELINE MEDINA
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Credential | M.S.
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Telephone | 951-836-6727
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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Taxonomy #2
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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 #3
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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 #4
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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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