Provider Demographics
NPI:1508952151
Name:GOTBAUM, MARC HUGH (LMFT)
Entity Type:Individual
Prefix:MR
First Name:MARC
Middle Name:HUGH
Last Name:GOTBAUM
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8787 COMPLEX DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-1419
Mailing Address - Country:US
Mailing Address - Phone:619-871-8446
Mailing Address - Fax:185-857-1196
Practice Address - Street 1:8787 COMPLEX DR
Practice Address - Street 2:SUITE 200
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-1419
Practice Address - Country:US
Practice Address - Phone:185-857-1196
Practice Address - Fax:185-857-1196
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 18875106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist