Provider Demographics
NPI:1083101711
Name:CONNECTIVE FAMILY THERAPY, INC.
Entity Type:Organization
Organization Name:CONNECTIVE FAMILY THERAPY, INC.
Other - Org Name:WELLSPACE MARRIAGE AND FAMILY THERAPY, INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:TARA
Authorized Official - Middle Name:DANIELLE
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:415-632-1010
Mailing Address - Street 1:870 MARKET ST STE 345
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94102-3022
Mailing Address - Country:US
Mailing Address - Phone:415-632-1010
Mailing Address - Fax:415-632-1010
Practice Address - Street 1:870 MARKET ST STE 345
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94102-3022
Practice Address - Country:US
Practice Address - Phone:415-632-1010
Practice Address - Fax:415-632-1010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-18
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Multi-Specialty