Provider Demographics
NPI:1518521293
Name:BREATHING SOL MARRIAGE AND FAMILY THERAPY, INC.
Entity Type:Organization
Organization Name:BREATHING SOL MARRIAGE AND FAMILY THERAPY, INC.
Other - Org Name:BREATHING SOL, INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:NAXYELI
Authorized Official - Middle Name:SAMANTHA
Authorized Official - Last Name:WHEELER
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:951-916-9955
Mailing Address - Street 1:33702 PETUNIA ST
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92563-3493
Mailing Address - Country:US
Mailing Address - Phone:951-916-9955
Mailing Address - Fax:
Practice Address - Street 1:29970 TECHNOLOGY DR STE 117B
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92563-2647
Practice Address - Country:US
Practice Address - Phone:951-916-9955
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-28
Last Update Date:2020-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1902039308Medicaid