Provider Demographics
NPI:1508000837
Name:MARRIAGE FAMILY AND CHILD THERAPIST, INC
Entity Type:Organization
Organization Name:MARRIAGE FAMILY AND CHILD THERAPIST, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO, PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:ERWIN-GALLAGHER
Authorized Official - Suffix:
Authorized Official - Credentials:MFT
Authorized Official - Phone:858-610-1460
Mailing Address - Street 1:8596 RUMEX LN
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92129-4142
Mailing Address - Country:US
Mailing Address - Phone:858-610-1460
Mailing Address - Fax:619-533-3459
Practice Address - Street 1:2423 CAMINO DEL RIO S
Practice Address - Street 2:SUITE 104
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3702
Practice Address - Country:US
Practice Address - Phone:858-610-1460
Practice Address - Fax:619-533-3459
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-30
Last Update Date:2009-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC15021106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty