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General NPI Number Information
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NPI Number | 1902338015
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Entity Type | Organization
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Legal Business Name | ASPIRE MARRIAGE & FAMILY THERAPY SERVICES A PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 03/28/2017
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Last Update Date | 03/28/2017
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Provider Practice Location Address
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Address Line | 715 N CENTRAL AVE SUITE 108
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City | GLENDALE
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State | CA
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Zip | 91203-4262
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Country | US
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Telephone | 818-660-5307
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Fax |
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Provider Business Mailing Address
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Address Line | 7035 WHITAKER AVE
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City | LAKE BALBOA
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State | CA
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Zip | 91406-3718
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Country | US
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Telephone | 818-660-5307
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Fax |
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Authorized Official
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Title or Position | OWNER & PRESIDENT
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Name | MRS. RACHEL FACIO
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Credential | LMFT
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Telephone | 818-400-1321
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 | 97351
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License Number State | CA
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