| Revolution Psychotherapy, A Family And Marriage Therapy Corporation | |
|
3319 Telegraph Rd Ste 108 Ventura CA 93003-3319 | |
| (805) 888-9254 | |
| (805) 669-3525 |
| Full Name | Revolution Psychotherapy, A Family And Marriage Therapy Corporation |
|---|---|
| Speciality | Marriage & Family Therapist |
| Location | 3319 Telegraph Rd Ste 108, Ventura, California |
| Authorized Official Name and Position | Micheal Frances Smith (PRESIDENT) |
| Authorized Official Contact | 8058889254 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Revolution Psychotherapy, A Family And Marriage Therapy Corporation 901 Mercer Ave Ojai CA 93023-2927 Ph: (805) 888-9254 | Revolution Psychotherapy, A Family And Marriage Therapy Corporation 3319 Telegraph Rd Ste 108 Ventura CA 93003-3319 Ph: (805) 888-9254 |
| NPI Number | 1811540909 |
|---|---|
| Provider Enumeration Date | 07/18/2019 |
| Last Update Date | 07/18/2019 |
| Medicare PECOS PAC ID | 3678916038 |
|---|---|
| Medicare Enrollment ID | O20240213002209 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1811540909 | NPI | - | NPPES |
| 1346513363 | Other | CA | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 106H00000X | Marriage & Family Therapist | (* (Not Available)) | Primary |
| Provider Name | Micheal Frances Smith |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1346513363 PECOS PAC ID: 5496198855 Enrollment ID: I20240213002385 |
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