Provider Demographics
NPI:1447721311
Name:THERAPY CENTER AND FAMILY COUNSELING CORPORATION
Entity type:Organization
Organization Name:THERAPY CENTER AND FAMILY COUNSELING CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMAK
Authorized Official - Middle Name:
Authorized Official - Last Name:RAZAVI
Authorized Official - Suffix:
Authorized Official - Credentials:MARRIAGE AND FAMILY
Authorized Official - Phone:310-948-3970
Mailing Address - Street 1:10070 MESA RIM RD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92121-2912
Mailing Address - Country:US
Mailing Address - Phone:310-948-3970
Mailing Address - Fax:858-724-2786
Practice Address - Street 1:9920 PACIFIC HEIGHTS BLVD STE 150
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-4361
Practice Address - Country:US
Practice Address - Phone:310-948-3970
Practice Address - Fax:858-724-2786
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-17
Last Update Date:2020-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB2019000162Medicaid