1013274646 NPI number — FAMILY THERAPY INSTITUTE OF SANTA BARBARA

Table of content: (NPI 1013274646)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013274646 NPI number — FAMILY THERAPY INSTITUTE OF SANTA BARBARA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FAMILY THERAPY INSTITUTE OF SANTA BARBARA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1013274646
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/26/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
111 E ARRELLAGA ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SANTA BARBARA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93101-1903
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
805-882-2400
Provider Business Mailing Address Fax Number:
805-882-2422

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
111 E ARRELLAGA ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SANTA BARBARA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93101-1903
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-882-2400
Provider Business Practice Location Address Fax Number:
805-882-2422
Provider Enumeration Date:
04/20/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MACMANNIS
Authorized Official First Name:
DON
Authorized Official Middle Name:
R.
Authorized Official Title or Position:
CLINICAL DIRECTOR/PSYCHOLOGIST
Authorized Official Telephone Number:
805-882-2400

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X , with the licence number:  PL 6727 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 1041C0700X , with the licence number: LR 9847 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 106H00000X , with the licence number: PL 6727 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)