Provider Demographics
NPI:1194411256
Name:MARRIAGE COUNSELING CTR SEXUAL HEALTH
Entity type:Organization
Organization Name:MARRIAGE COUNSELING CTR SEXUAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JACKSON
Authorized Official - Middle Name:DELORD
Authorized Official - Last Name:SOUSA
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:805-308-9800
Mailing Address - Street 1:2660 TOWNSGATE RD STE 520
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91361-5712
Mailing Address - Country:US
Mailing Address - Phone:805-308-9800
Mailing Address - Fax:805-230-2210
Practice Address - Street 1:2660 TOWNSGATE RD STE 520
Practice Address - Street 2:
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91361-5712
Practice Address - Country:US
Practice Address - Phone:805-308-9800
Practice Address - Fax:805-230-2210
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-12
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty