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Organization

COURAGEOUS LOVE WORKS THERAPY LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
EXECUTIVE DIRECTOR (DIRECTOR)
(415) 000-0000
Entity
Organization

Contact information

Practice address
1545 N TEXAS ST STE 201, FAIRFIELD, CA 94533-5623
(415) 413-8592
Mailing address
1545 N TEXAS ST STE 201, FAIRFIELD, CA 94533-5623
(415) 000-0000

Taxonomy

Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
103TC1900X
Counseling Psychologist
261Q00000X
Clinic/Center
Primary
261QM0850X
Adult Mental Health Clinic/Center
261QM0855X
Adolescent and Children Mental Health Clinic/Center
390200000X
Student in an Organized Health Care Education/Training Program

Other

Enumeration date
11/21/2025
Last updated
12/12/2025
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