Provider Demographics
NPI:1457422552
Name:ASSOCIATED CHRISTIAN THERAPY SERVICES A MARRIAGE FAMILY & CHILD
Entity type:Organization
Organization Name:ASSOCIATED CHRISTIAN THERAPY SERVICES A MARRIAGE FAMILY & CHILD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:OLSON
Authorized Official - Suffix:
Authorized Official - Credentials:MFT
Authorized Official - Phone:661-940-4861
Mailing Address - Street 1:41765 12TH ST W STE D
Mailing Address - Street 2:
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93551-1422
Mailing Address - Country:US
Mailing Address - Phone:661-940-4861
Mailing Address - Fax:661-942-4511
Practice Address - Street 1:41765 12TH ST W STE D
Practice Address - Street 2:
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93551-1422
Practice Address - Country:US
Practice Address - Phone:661-940-4861
Practice Address - Fax:661-942-4511
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-11
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 27410106H00000X
101YM0800X, 103TP2701X
CAMFC35634106H00000X
CAMFC 35177106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
Not Answered103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup PsychotherapyGroup - Multi-Specialty