Provider Demographics
NPI:1063751303
Name:CROSS CULTURAL MARRIAGE AND FAMILYTHERAPY COUNSELLING CE
Entity type:Organization
Organization Name:CROSS CULTURAL MARRIAGE AND FAMILYTHERAPY COUNSELLING CE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:BETTY
Authorized Official - Middle Name:BA
Authorized Official - Last Name:ODAK
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:562-522-8008
Mailing Address - Street 1:PO BOX 10908
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92423-0908
Mailing Address - Country:US
Mailing Address - Phone:562-522-8008
Mailing Address - Fax:909-335-5991
Practice Address - Street 1:535 W STATE ST
Practice Address - Street 2:SUITE # C
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373-4662
Practice Address - Country:US
Practice Address - Phone:562-522-8008
Practice Address - Fax:909-335-5991
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CROSS CULTURAL MFT COUNSELING CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-02-06
Last Update Date:2013-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251S00000X
CA106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty