Provider Demographics
NPI:1124814769
Name:PHILLIP CLEAVER MARRIAGE AND FAMILY THERAPY INC
Entity type:Organization
Organization Name:PHILLIP CLEAVER MARRIAGE AND FAMILY THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:F
Authorized Official - Last Name:CLEAVER
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:323-920-5013
Mailing Address - Street 1:3662 KATELLA AVE STE 209
Mailing Address - Street 2:
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-6404
Mailing Address - Country:US
Mailing Address - Phone:323-920-5013
Mailing Address - Fax:
Practice Address - Street 1:3662 KATELLA AVE STE 209
Practice Address - Street 2:
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-6404
Practice Address - Country:US
Practice Address - Phone:323-920-5013
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-18
Last Update Date:2025-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health