1508000837 NPI number — MARRIAGE FAMILY AND CHILD THERAPIST, INC

Table of content: (NPI 1508000837)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508000837 NPI number — MARRIAGE FAMILY AND CHILD THERAPIST, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARRIAGE FAMILY AND CHILD THERAPIST, INC
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:
1508000837
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/04/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8596 RUMEX LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN DIEGO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92129-4142
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
858-610-1460
Provider Business Mailing Address Fax Number:
619-533-3459

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2423 CAMINO DEL RIO S
Provider Second Line Business Practice Location Address:
SUITE 104
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92108-3702
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-610-1460
Provider Business Practice Location Address Fax Number:
619-533-3459
Provider Enumeration Date:
04/30/2009

Additional Information

Authorized Official

Authorized Official Last Name:
ERWIN-GALLAGHER
Authorized Official First Name:
LINDA
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO, PRESIDENT
Authorized Official Telephone Number:
858-610-1460

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X , with the licence number:  MFC15021 , 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)





Copyright © 2007-2024 www.npivalidator.com