1346073848 NPI number — RELATIONSHIPS, A MARRIAGE, FAMILY THERAPY AND EDUCATIONAL PSYCHOLOGY

Table of content: (NPI 1346073848)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346073848 NPI number — RELATIONSHIPS, A MARRIAGE, FAMILY THERAPY AND EDUCATIONAL PSYCHOLOGY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RELATIONSHIPS, A MARRIAGE, FAMILY THERAPY AND EDUCATIONAL PSYCHOLOGY
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:
1346073848
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/21/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15425 OAK GLEN AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MORGAN HILL
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95037-8802
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
408-203-4401
Provider Business Mailing Address Fax Number:
408-351-0333

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
605 TENNANT AVE STE G
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MORGAN HILL
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95037-5529
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
408-415-0267
Provider Business Practice Location Address Fax Number:
408-321-0333
Provider Enumeration Date:
08/21/2024

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BETTENCOURT
Authorized Official First Name:
JEFFREY
Authorized Official Middle Name:
EUGENE
Authorized Official Title or Position:
CEO AND PRESIDENT
Authorized Official Telephone Number:
408-415-0267

Provider Taxonomy Codes

  • Taxonomy code: 103TB0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TM1800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 106H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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