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General NPI Number Information
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NPI Number | 1881333441
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Entity Type | Organization
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Legal Business Name | SAFE SPACE MARRIAGE & FAMILY COUNSELING CORP
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Dates
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Enumeration Date | 06/01/2022
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Last Update Date | 06/01/2022
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Provider Practice Location Address
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Address Line | 28100 BOUQUET CANYON RD STE 201
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City | SANTA CLARITA
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State | CA
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Zip | 91350-2006
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Country | US
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Telephone | 661-212-2997
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Fax | 833-766-3523
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Provider Business Mailing Address
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Address Line | 19684 NEWHOUSE ST
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City | CANYON COUNTRY
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State | CA
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Zip | 91351-2048
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Country | US
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Telephone | 661-212-2997
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Fax | 833-766-3523
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. HEATHER ROUSSELO
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Credential | LMFT
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Telephone | 661-212-2997
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TP2701X
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Taxonomy Name | Group Psychotherapy Psychologist
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License Number |
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License Number State |
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