Provider Demographics
NPI:1780445676
Name:PRIORITY: LOVE. A MARRIAGE AND FAMILY THERAPY CORPORATION
Entity type:Organization
Organization Name:PRIORITY: LOVE. A MARRIAGE AND FAMILY THERAPY CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:910-551-2166
Mailing Address - Street 1:16530 VENTURA BLVD STE 400
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-4551
Mailing Address - Country:US
Mailing Address - Phone:818-538-4225
Mailing Address - Fax:
Practice Address - Street 1:5308 RIVERTON AVE APT 7
Practice Address - Street 2:
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91601-3325
Practice Address - Country:US
Practice Address - Phone:910-551-2166
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-18
Last Update Date:2024-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty