Angel Bridge, Inc

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

MA14528 Issued in CA

Legal business name

ANGEL BRIDGE, INC

Practice address

1414 E Thousand Oaks Blvd
#103
Thousand Oaks, CA 91362-4401

Phone

(805) 371-1679

NPI assigned

Nov 14, 2006

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Mary Jayne Carlson-Collins, PH.D.

Title

Owner

Phone

(805) 371-1679

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1163462400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1578635629",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1414 E THOUSAND OAKS BLVD",
            "address_2": "#103",
            "city": "THOUSAND OAKS",
            "state": "CA",
            "postal_code": "913624401",
            "telephone_number": "805-371-1679"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1414 E THOUSAND OAKS BLVD",
            "address_2": "#103",
            "city": "THOUSAND OAKS",
            "state": "CA",
            "postal_code": "913624401",
            "telephone_number": "805-371-1679"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ANGEL BRIDGE, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-14",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "CARLSON-COLLINS",
        "authorized_official_first_name": "MARY JAYNE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "805-371-1679",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "MA14528",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Marriage & Family Therapist in Thousand Oaks, CA
• Providers in Thousand Oaks, CA by specialty
• Marriage & Family Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.