Provider Demographics
NPI:1528637519
Name:FULL BRAIN FAMILY THERAPY INC
Entity type:Organization
Organization Name:FULL BRAIN FAMILY THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/LEAD THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MORGAN
Authorized Official - Middle Name:
Authorized Official - Last Name:PEMBERTON
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:949-464-8055
Mailing Address - Street 1:27762 ANTONIO PKWY STE L1
Mailing Address - Street 2:#251
Mailing Address - City:LADERA RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:92694-1141
Mailing Address - Country:US
Mailing Address - Phone:949-464-8055
Mailing Address - Fax:
Practice Address - Street 1:29829 SANTA MARGARITA PKWY
Practice Address - Street 2:
Practice Address - City:RANCHO SANTA MARGARITA
Practice Address - State:CA
Practice Address - Zip Code:92688-3622
Practice Address - Country:US
Practice Address - Phone:949-464-8055
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-23
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty