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NPI Code Detail

MEDICARE: CONNER FAMILY THERAPY, INC.

MEDICARE: CONNER FAMILY THERAPY, INC.
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
1101YM0800XMental Health Counselor

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1LMFT104888OTHERCABOARD OF BEHAVIORAL SCIENCES

General Provider Information

NPI Number : 1659964575
Entity Type Code : Organization
Provider Name (Legal Business Name) : CONNER FAMILY THERAPY, INC.
Provider Business Mailing Address
First Line : 25050 AVENUE KEARNY STE 203
Second Line :
City : VALENCIA
State : CA
Zip : 91355-1257
Country : US
Telephone Number : 818-257-0947
Fax Number :
Provider Business Practice Location Address
First Line : 25050 AVENUE KEARNY STE 203
Second Line :
City : VALENCIA
State : CA
Zip : 91355-1257
Country : US
Telephone Number : 818-257-0947
Fax Number :
Authorized Official
Title or Position : LMFT
Name : MRS. MARITZA CONNER
Credential : LMFT104888
Telephone Number : 818-257-0947
Provider Enumeration Date : 02/12/2021
Last Update Date : 02/12/2021

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Directions to “CONNER FAMILY THERAPY, INC. ” Practice Location

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