Provider Demographics
NPI:1629692397
Name:TLC FAMILY THERAPY CORP
Entity Type:Organization
Organization Name:TLC FAMILY THERAPY CORP
Other - Org Name:SAN DIEGO MEDICAL PAIN AND TRAMA INSTITUTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FOUNDER/CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TRACEY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:CHESTER
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:858-531-3795
Mailing Address - Street 1:5965 VILLAGE WAY. SUITE 105 #112
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92130
Mailing Address - Country:US
Mailing Address - Phone:442-777-2040
Mailing Address - Fax:858-408-4494
Practice Address - Street 1:5405 MOREHOUSE DR STE 120
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-4723
Practice Address - Country:US
Practice Address - Phone:442-777-2040
Practice Address - Fax:858-408-4494
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-29
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty