Provider Demographics
NPI:1992107007
Name:CENTER FOR THERAPEUTIC ALLIANCE
Entity type:Organization
Organization Name:CENTER FOR THERAPEUTIC ALLIANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:M
Authorized Official - Last Name:GLICKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MFT
Authorized Official - Phone:805-610-8729
Mailing Address - Street 1:625 14TH ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:PASO ROBLES
Mailing Address - State:CA
Mailing Address - Zip Code:93446-2285
Mailing Address - Country:US
Mailing Address - Phone:805-876-5413
Mailing Address - Fax:805-876-5412
Practice Address - Street 1:625 14TH ST
Practice Address - Street 2:SUITE B
Practice Address - City:PASO ROBLES
Practice Address - State:CA
Practice Address - Zip Code:93446-2285
Practice Address - Country:US
Practice Address - Phone:805-876-5413
Practice Address - Fax:805-876-5412
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-19
Last Update Date:2014-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY26358103T00000X
CAMFC49152106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty