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5308 Riverton Ave Apt 7 North Hollywood CA 91601-3325 | |
| (910) 551-2166 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Marriage & Family Therapist |
| Location | 5308 Riverton Ave Apt 7, North Hollywood, California |
| Authorized Official Name and Position | Crystal Clark (CEO) |
| Authorized Official Contact | 9105512166 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
16530 Ventura Blvd Ste 400 Encino CA 91436-4551 Ph: (818) 538-4225 | 5308 Riverton Ave Apt 7 North Hollywood CA 91601-3325 Ph: (910) 551-2166 |
| NPI Number | 1780445676 |
|---|---|
| Provider Enumeration Date | 01/18/2024 |
| Last Update Date | 12/22/2024 |
| Certification Date | 12/22/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1780445676 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 106H00000X | Marriage & Family Therapist | (* (Not Available)) | Primary |
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