1407955016 NPI number — BETH CORRICK MFT

Table of content: DR. JEREMY SCOTT JOHNSON M.D. (NPI 1548249097)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407955016 NPI number — BETH CORRICK MFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BETH CORRICK MFT
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:
1407955016
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/27/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1074
Provider Second Line Business Mailing Address:
CARDIFF, CA 92007
Provider Business Mailing Address City Name:
CARDIFF BY THE SEA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92007-7074
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
858-699-1497
Provider Business Mailing Address Fax Number:
858-481-8271

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5752 OBERLIN DR STE 203
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92121-1749
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-699-1497
Provider Business Practice Location Address Fax Number:
858-481-8271
Provider Enumeration Date:
09/21/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
CORRICK
Authorized Official First Name:
BETH
Authorized Official Middle Name:
Authorized Official Title or Position:
MARRIAGE AND FAMILY THERAPIST
Authorized Official Telephone Number:
858-699-1497

Provider Taxonomy Codes

  • Taxonomy code: 302R00000X , with the licence number:  MFC 46498 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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