Organization · NPI-2

8616 Group, LLC

Marriage & Family Therapist · Los Angeles, CA

NPI number1750749784
StatusActive
Last updated in NPPESFeb 4, 2016

Details

NPI
1750749784
Entity type
Organization (NPI-2)
Legal business name
8616 Group, LLC
Organization subpart
No
Enumeration date
Feb 4, 2016
Last updated
Feb 4, 2016

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
106H00000X Marriage & Family TherapistMFT47879CAYes

Practice location

8616 La Tijera Blvd
Suite 404
Los Angeles, CA 90045-3944

Phone 310-982-6062

Mailing address

8616 La Tijera Blvd
Suite 404
Los Angeles, CA 90045-3944

Phone 310-982-6062

Authorized official

Darin Bennett
Clinical Director
3102881718

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