Provider Demographics
NPI:1619024809
Name:GUIDING MINDFUL CHANGE
Entity Type:Organization
Organization Name:GUIDING MINDFUL CHANGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:BILLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:FRANCES
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:858-571-7857
Mailing Address - Street 1:5663 BALBOA AVE
Mailing Address - Street 2:438
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92111-2705
Mailing Address - Country:US
Mailing Address - Phone:858-571-7857
Mailing Address - Fax:858-571-8764
Practice Address - Street 1:3245 E FOX RUN WAY
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92111-7747
Practice Address - Country:US
Practice Address - Phone:858-571-7857
Practice Address - Fax:858-571-8764
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC30354106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty