Provider Demographics
NPI:1518234657
Name:MISSION FAMILY THERAPY, INC.
Entity Type:Organization
Organization Name:MISSION FAMILY THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:FRANKLIN
Authorized Official - Last Name:WORKMAN
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:415-200-5982
Mailing Address - Street 1:PO BOX 2029
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94126-2029
Mailing Address - Country:US
Mailing Address - Phone:415-200-5982
Mailing Address - Fax:415-358-8222
Practice Address - Street 1:2345 CALIFORNIA ST
Practice Address - Street 2:SUITE 7
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-2747
Practice Address - Country:US
Practice Address - Phone:415-200-5982
Practice Address - Fax:415-358-8222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-17
Last Update Date:2011-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT14419103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty