Provider Demographics
NPI:1558104208
Name:INNER CHILD THERAPY CORP
Entity type:Organization
Organization Name:INNER CHILD THERAPY CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MEHDI
Authorized Official - Middle Name:ANTHONTY
Authorized Official - Last Name:OWLIAIE
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:702-239-7700
Mailing Address - Street 1:7560 CORBIN AVE UNIT 5
Mailing Address - Street 2:
Mailing Address - City:RESEDA
Mailing Address - State:CA
Mailing Address - Zip Code:91335-2425
Mailing Address - Country:US
Mailing Address - Phone:702-239-7700
Mailing Address - Fax:
Practice Address - Street 1:7560 CORBIN AVE UNIT 5
Practice Address - Street 2:
Practice Address - City:RESEDA
Practice Address - State:CA
Practice Address - Zip Code:91335-2425
Practice Address - Country:US
Practice Address - Phone:702-239-7700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-18
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty