Provider Demographics
NPI:1164028007
Name:MIYOUNG SON MARRIAGE FAMILY THERAPY
Entity Type:Organization
Organization Name:MIYOUNG SON MARRIAGE FAMILY THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:MIYOUNG
Authorized Official - Middle Name:
Authorized Official - Last Name:SON
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:323-452-1955
Mailing Address - Street 1:3660 RUFFIN RD STE C
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-1877
Mailing Address - Country:US
Mailing Address - Phone:323-452-1955
Mailing Address - Fax:619-701-6657
Practice Address - Street 1:3660 RUFFIN RD STE C
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-1877
Practice Address - Country:US
Practice Address - Phone:323-452-1955
Practice Address - Fax:619-701-6657
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-07
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty