Provider Demographics
NPI:1629641311
Name:LIVING WITHIN THERAPY- MARRIAGE AND FAMILY THERAPY
Entity Type:Organization
Organization Name:LIVING WITHIN THERAPY- MARRIAGE AND FAMILY THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JACLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:NEMATBAKHSH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-880-6427
Mailing Address - Street 1:3505 CAMINO DEL RIO S STE 338
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-4017
Mailing Address - Country:US
Mailing Address - Phone:619-880-6427
Mailing Address - Fax:
Practice Address - Street 1:3505 CAMINO DEL RIO S STE 338
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-4017
Practice Address - Country:US
Practice Address - Phone:619-880-6427
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-20
Last Update Date:2021-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty