Provider Demographics
NPI:1447511084
Name:ARTEMIS CENTER FOR FAMILY, A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:ARTEMIS CENTER FOR FAMILY, A PROFESSIONAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/CFO
Authorized Official - Prefix:MRS
Authorized Official - First Name:ARTEMIS
Authorized Official - Middle Name:
Authorized Official - Last Name:TEGAN
Authorized Official - Suffix:
Authorized Official - Credentials:MFC
Authorized Official - Phone:310-809-2011
Mailing Address - Street 1:1621 W. 25TH STREET, #221
Mailing Address - Street 2:
Mailing Address - City:SAN PEDRO
Mailing Address - State:CALIFORNIA
Mailing Address - Zip Code:90732
Mailing Address - Country:UM
Mailing Address - Phone:310-809-2011
Mailing Address - Fax:310-832-0862
Practice Address - Street 1:815 S AVERILL AVE
Practice Address - Street 2:
Practice Address - City:SAN PEDRO
Practice Address - State:CA
Practice Address - Zip Code:90732-3815
Practice Address - Country:US
Practice Address - Phone:310-809-2011
Practice Address - Fax:310-832-0862
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-30
Last Update Date:2012-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA42001106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty