Provider Demographics
NPI:1114704228
Name:PSYCHOTHERAPIST COACH A MARRIAGE AND FAMILY THERAPIST CORPORATION
Entity Type:Organization
Organization Name:PSYCHOTHERAPIST COACH A MARRIAGE AND FAMILY THERAPIST CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:LYNNDAL
Authorized Official - Middle Name:K
Authorized Official - Last Name:DANIELS
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LMFT
Authorized Official - Phone:415-712-2328
Mailing Address - Street 1:534 AVALON DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94080-5558
Mailing Address - Country:US
Mailing Address - Phone:805-807-3574
Mailing Address - Fax:415-614-4206
Practice Address - Street 1:534 AVALON DR
Practice Address - Street 2:
Practice Address - City:SOUTH SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94080-5558
Practice Address - Country:US
Practice Address - Phone:805-807-3574
Practice Address - Fax:415-614-4206
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-12
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty