Provider Demographics
NPI:1811435910
Name:CO-PADRES PSYCHOTHERAPEUTIC SERCICES
Entity type:Organization
Organization Name:CO-PADRES PSYCHOTHERAPEUTIC SERCICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:BARELA
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:714-260-4517
Mailing Address - Street 1:460 E CARSON PLAZA DR
Mailing Address - Street 2:215
Mailing Address - City:CARSON
Mailing Address - State:CA
Mailing Address - Zip Code:90746-3228
Mailing Address - Country:US
Mailing Address - Phone:714-260-4517
Mailing Address - Fax:
Practice Address - Street 1:460 E CARSON PLAZA DR
Practice Address - Street 2:215
Practice Address - City:CARSON
Practice Address - State:CA
Practice Address - Zip Code:90746-3228
Practice Address - Country:US
Practice Address - Phone:714-260-4517
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-08
Last Update Date:2017-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT95361106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1891029468Medicaid