Provider Demographics
NPI:1679390207
Name:CLOVER FAMILY THERAPY, INC.
Entity type:Organization
Organization Name:CLOVER FAMILY THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:JANINE
Authorized Official - Middle Name:E
Authorized Official - Last Name:DOOLAN
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LMFT
Authorized Official - Phone:310-425-3729
Mailing Address - Street 1:9531 SANTA MONICA BLVD STE 1020
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-4503
Mailing Address - Country:US
Mailing Address - Phone:310-498-4084
Mailing Address - Fax:
Practice Address - Street 1:7604 N PATRIOT WAY
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91405-5647
Practice Address - Country:US
Practice Address - Phone:310-425-3729
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-24
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty