Provider Demographics
NPI:1043977945
Name:TRUE ESCAPE MARRIAGE AND FAMILY THERAPY, PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:TRUE ESCAPE MARRIAGE AND FAMILY THERAPY, PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MERCEDES
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:951-801-0119
Mailing Address - Street 1:PO BOX 2425
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92393-2425
Mailing Address - Country:US
Mailing Address - Phone:951-801-0119
Mailing Address - Fax:
Practice Address - Street 1:13261 SPRING VALLEY PRKWY
Practice Address - Street 2:205
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395
Practice Address - Country:US
Practice Address - Phone:442-243-2714
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-26
Last Update Date:2021-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare