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General NPI Number Information
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NPI Number | 1932904513
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Entity Type | Organization
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Legal Business Name | ADVENTURE THERAPY ASSOCIATESA 501(C)(3) SERVING CALIFORNIA (FEDERAL APPLICATION PENDING)
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Dates
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Enumeration Date | 02/17/2025
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Last Update Date | 02/17/2025
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Provider Practice Location Address
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Address Line | 7305 MORRO RD STE 205
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City | ATASCADERO
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State | CA
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Zip | 93422-4445
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Country | US
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Telephone | 805-540-4209
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Fax |
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Provider Business Mailing Address
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Address Line | 7305 MORRO RD STE 205
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City | ATASCADERO
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State | CA
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Zip | 93422-4445
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Country | US
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Telephone | 805-540-4209
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR/PRESIDENT
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Name | CHRISTIN MARIE FREDERICK
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Credential | LMFT
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Telephone | 805-540-4209
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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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