Provider Demographics
NPI:1902339906
Name:MOMENTUM COUPLES AND FAMILY THERAPY LLC
Entity Type:Organization
Organization Name:MOMENTUM COUPLES AND FAMILY THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:FRANCISCO
Authorized Official - Middle Name:
Authorized Official - Last Name:ZEPEDA
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:724-317-9311
Mailing Address - Street 1:17219 FUTCH WAY
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46074-8802
Mailing Address - Country:US
Mailing Address - Phone:724-317-9311
Mailing Address - Fax:
Practice Address - Street 1:120 CAMILLA CT
Practice Address - Street 2:STE D
Practice Address - City:WESTFIELD
Practice Address - State:IN
Practice Address - Zip Code:46074-9863
Practice Address - Country:US
Practice Address - Phone:724-317-9311
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-06
Last Update Date:2017-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN35001965A251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health