MEDICARE: ANNA J HORNBOSTEL MARRIAGE AND FAMILY THERAPY CORPORATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1023761194
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANNA J HORNBOSTEL MARRIAGE AND FAMILY THERAPY CORPORATION

Provider Business Mailing Address
First Line	:	27285 LAS RAMBLAS STE 140
Second Line	:
City	:	MISSION VIEJO
State	:	CA
Zip	:	92691-8551
Country	:	US
Telephone Number	:	949-528-5037
Fax Number	:

Provider Business Practice Location Address
First Line	:	27285 LAS RAMBLAS STE 140
Second Line	:
City	:	MISSION VIEJO
State	:	CA
Zip	:	92691-8551
Country	:	US
Telephone Number	:	949-528-5037
Fax Number	:

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER/OWNER
Name	:	ANNA HORNBOSTEL
Credential	:	LMFT
Telephone Number	:	949-528-5037

Provider Enumeration Date	:	01/30/2022
Last Update Date	:	01/30/2022

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