Provider Demographics
NPI:1902338015
Name:ASPIRE MARRIAGE & FAMILY THERAPY SERVICES A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:ASPIRE MARRIAGE & FAMILY THERAPY SERVICES A PROFESSIONAL CORPORATION
Other - Org Name:ASPIRE THERAPEUTIC SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER & PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:
Authorized Official - Last Name:FACIO
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:818-400-1321
Mailing Address - Street 1:7035 WHITAKER AVE
Mailing Address - Street 2:
Mailing Address - City:LAKE BALBOA
Mailing Address - State:CA
Mailing Address - Zip Code:91406-3718
Mailing Address - Country:US
Mailing Address - Phone:818-660-5307
Mailing Address - Fax:
Practice Address - Street 1:715 N CENTRAL AVE
Practice Address - Street 2:SUITE 108
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91203-4262
Practice Address - Country:US
Practice Address - Phone:818-660-5307
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-28
Last Update Date:2017-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA97351261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health