Provider Demographics
NPI:1730712761
Name:CREATING CHANGE LA, INDIVIDUAL & COUPLE MARRIAGE COUNSELING & SEX THER
Entity type:Organization
Organization Name:CREATING CHANGE LA, INDIVIDUAL & COUPLE MARRIAGE COUNSELING & SEX THER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NATALIE
Authorized Official - Middle Name:FINEGOOD
Authorized Official - Last Name:GOLDBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-963-4216
Mailing Address - Street 1:337 S BEVERLY DR STE 201
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90212-4308
Mailing Address - Country:US
Mailing Address - Phone:310-963-4216
Mailing Address - Fax:
Practice Address - Street 1:337 S BEVERLY DR STE 201
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90212-4308
Practice Address - Country:US
Practice Address - Phone:310-963-4216
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-18
Last Update Date:2020-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty