Provider Demographics
NPI:1245990779
Name:ELITE MENTAL HEALTH AND FAMILY THERAPY
Entity type:Organization
Organization Name:ELITE MENTAL HEALTH AND FAMILY THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JORDAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BUNTING
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:949-482-5937
Mailing Address - Street 1:32412 CROWN VALLEY PKWY APT 202
Mailing Address - Street 2:
Mailing Address - City:DANA POINT
Mailing Address - State:CA
Mailing Address - Zip Code:92629-3336
Mailing Address - Country:US
Mailing Address - Phone:949-482-5937
Mailing Address - Fax:
Practice Address - Street 1:32412 CROWN VALLEY PKWY APT 202
Practice Address - Street 2:
Practice Address - City:DANA POINT
Practice Address - State:CA
Practice Address - Zip Code:92629-3336
Practice Address - Country:US
Practice Address - Phone:949-482-5937
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-24
Last Update Date:2021-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health