Provider Demographics
NPI:1255030649
Name:EFFECTIVE THERAPY INDIVIDUAL RELATIONSHIP FAMILY AND CHILD COUN
Entity type:Organization
Organization Name:EFFECTIVE THERAPY INDIVIDUAL RELATIONSHIP FAMILY AND CHILD COUN
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BILLING/CREDENTIALING
Authorized Official - Prefix:MS
Authorized Official - First Name:MEGHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:TRACY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-433-8023
Mailing Address - Street 1:24050 MADISON ST STE 217
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-6017
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:310-373-4564
Practice Address - Street 1:24050 MADISON ST STE 217
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-6017
Practice Address - Country:US
Practice Address - Phone:310-463-6638
Practice Address - Fax:310-373-4564
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-24
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty