Provider Demographics
NPI:1013719939
Name:MESH FAMILY THERAPY COLLECTIVE, INC.
Entity type:Organization
Organization Name:MESH FAMILY THERAPY COLLECTIVE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:
Authorized Official - Last Name:WAITT
Authorized Official - Suffix:
Authorized Official - Credentials:MFT
Authorized Official - Phone:858-736-7003
Mailing Address - Street 1:1155 S WINDSOR BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90019-3158
Mailing Address - Country:US
Mailing Address - Phone:858-736-7003
Mailing Address - Fax:858-736-7003
Practice Address - Street 1:1150 S ROBERTSON BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90035-1404
Practice Address - Country:US
Practice Address - Phone:424-333-4551
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-24
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health