Provider Demographics
NPI:1023906575
Name:AUTHENTICALLY THRIVE MARRIAGE & FAMILY THERAPY, INC.
Entity type:Organization
Organization Name:AUTHENTICALLY THRIVE MARRIAGE & FAMILY THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LMFT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANA
Authorized Official - Middle Name:CAROLINE
Authorized Official - Last Name:LEON WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:650-989-0403
Mailing Address - Street 1:501 1ST AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94401-3476
Mailing Address - Country:US
Mailing Address - Phone:650-989-0403
Mailing Address - Fax:
Practice Address - Street 1:501 1ST AVE STE 1
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94401-3476
Practice Address - Country:US
Practice Address - Phone:650-989-0403
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-25
Last Update Date:2025-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty