Provider Demographics
NPI:1053342725
Name:NEW LIFE MFT
Entity type:Organization
Organization Name:NEW LIFE MFT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CLINICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:GARNER
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LMFT
Authorized Official - Phone:661-947-0137
Mailing Address - Street 1:1305 E PALMDALE BLVD
Mailing Address - Street 2:SUITE 10
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93550-4853
Mailing Address - Country:US
Mailing Address - Phone:661-947-0137
Mailing Address - Fax:661-947-0860
Practice Address - Street 1:1305 E PALMDALE BLVD
Practice Address - Street 2:SUITE 10
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93550-4853
Practice Address - Country:US
Practice Address - Phone:661-947-0137
Practice Address - Fax:661-947-0860
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2008-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC022672106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty