Provider Demographics
NPI:1023628211
Name:TALK THERAPY MENTAL HEALTH
Entity type:Organization
Organization Name:TALK THERAPY MENTAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:ROCHA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-954-0165
Mailing Address - Street 1:241 W ROOSEVELT RD
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90807-3259
Mailing Address - Country:US
Mailing Address - Phone:949-954-0165
Mailing Address - Fax:949-861-9246
Practice Address - Street 1:1100 QUAIL ST STE 206
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-2782
Practice Address - Country:US
Practice Address - Phone:949-954-0165
Practice Address - Fax:949-861-9246
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-03
Last Update Date:2020-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1861678260Medicaid