Provider Demographics
NPI:1245771260
Name:FALCONE INSTITUTE EDUCATIONAL CHILD AND FAMILY THERAPIST APC
Entity Type:Organization
Organization Name:FALCONE INSTITUTE EDUCATIONAL CHILD AND FAMILY THERAPIST APC
Other - Org Name:FALCONE INSTITUTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KRISTIN
Authorized Official - Middle Name:MAURINE
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:858-229-4438
Mailing Address - Street 1:12520 HIGH BLUFF DRIVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92130
Mailing Address - Country:US
Mailing Address - Phone:858-792-8316
Mailing Address - Fax:858-792-8948
Practice Address - Street 1:12520 HIGH BLUFF DRIVE
Practice Address - Street 2:SUITE 100
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92130
Practice Address - Country:US
Practice Address - Phone:858-792-8316
Practice Address - Fax:858-792-8948
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-09
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA24414106H00000X
106H00000X, 235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1578139770Medicaid