Provider Demographics
NPI:1235374794
Name:HARTEN, TOM (MFT)
Entity Type:Individual
Prefix:
First Name:TOM
Middle Name:
Last Name:HARTEN
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9666 BUSINESSPARK AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92131-1646
Mailing Address - Country:US
Mailing Address - Phone:858-384-5854
Mailing Address - Fax:
Practice Address - Street 1:9666 BUSINESSPARK AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92131-1646
Practice Address - Country:US
Practice Address - Phone:858-384-5854
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-11
Last Update Date:2012-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC27227106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist