Provider Demographics
NPI:1962874313
Name:SOMA THERAPY CLINIC
Entity type:Organization
Organization Name:SOMA THERAPY CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-FOUNDER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:GUADALUPE
Authorized Official - Last Name:ALFARO
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:818-744-7256
Mailing Address - Street 1:2057 WILSHIRE BOULEVARD
Mailing Address - Street 2:SUITE 801
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90057
Mailing Address - Country:US
Mailing Address - Phone:818-455-4130
Mailing Address - Fax:
Practice Address - Street 1:2057 WILSHIRE BOULEVARD
Practice Address - Street 2:SUITE 801
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90057
Practice Address - Country:US
Practice Address - Phone:818-455-4130
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-26
Last Update Date:2015-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47737106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1427181064OtherNPI