Provider Demographics
NPI:1386419257
Name:MENDING WITHIN FAMILY THERAPY, INC.
Entity type:Organization
Organization Name:MENDING WITHIN FAMILY THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MEGAN
Authorized Official - Middle Name:R
Authorized Official - Last Name:KELLER
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:949-648-3698
Mailing Address - Street 1:13041 BRITTANY WOODS DR STE C
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-3909
Mailing Address - Country:US
Mailing Address - Phone:949-648-3698
Mailing Address - Fax:
Practice Address - Street 1:14751 PLAZA DR STE C
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-2773
Practice Address - Country:US
Practice Address - Phone:949-284-1991
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-20
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty