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General NPI Number Information
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NPI Number | 1912251018
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Entity Type | Organization
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Legal Business Name | FAMILY OUTREACH COUNSELING
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Dates
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Enumeration Date | 10/29/2012
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Last Update Date | 10/29/2012
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Provider Practice Location Address
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Address Line | 4401 ATLANTIC AVE STE 231
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City | LONG BEACH
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State | CA
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Zip | 90807-2246
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Country | US
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Telephone | 562-984-2012
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Fax | 562-984-2022
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Provider Business Mailing Address
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Address Line | 4401 ATLANTIC AVE STE 231
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City | LONG BEACH
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State | CA
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Zip | 90807-2246
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Country | US
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Telephone | 562-984-2012
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Fax | 562-984-2022
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. MARY M SIMMS
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Credential | PH.D
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Telephone | 562-984-2012
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | MFT 28731
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License Number State | CA
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