Provider Demographics
NPI:1659777662
Name:FAMILYCOUNSELINGSANDIEGO COM PC
Entity Type:Organization
Organization Name:FAMILYCOUNSELINGSANDIEGO COM PC
Other - Org Name:FAMILYCOUNSEILNGSANDIEGO.COM, INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:JANET
Authorized Official - Middle Name:P
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:760-498-1053
Mailing Address - Street 1:10650 SCRIPPS RANCH BLVD
Mailing Address - Street 2:STE 131
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92131-2470
Mailing Address - Country:US
Mailing Address - Phone:760-498-1053
Mailing Address - Fax:619-924-9931
Practice Address - Street 1:10650 SCRIPPS RANCH BLVD
Practice Address - Street 2:STE 131
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92131-2470
Practice Address - Country:US
Practice Address - Phone:760-498-1053
Practice Address - Fax:619-924-9931
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-18
Last Update Date:2017-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS243241041C0700X
CALMFT51509106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1003932799Medicaid