Provider Demographics
NPI:1194289975
Name:INTERIOR DESIGN FIRM - A PSYCHOTHERAPY PRACTICE INC
Entity type:Organization
Organization Name:INTERIOR DESIGN FIRM - A PSYCHOTHERAPY PRACTICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:N
Authorized Official - Last Name:FLORES
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:310-740-0482
Mailing Address - Street 1:4421 W RIVERSIDE DR STE 102
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91505-4051
Mailing Address - Country:US
Mailing Address - Phone:818-748-8818
Mailing Address - Fax:
Practice Address - Street 1:4421 W RIVERSIDE DR STE 102
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505-4051
Practice Address - Country:US
Practice Address - Phone:818-748-8818
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-25
Last Update Date:2019-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty