Provider Demographics
NPI:1679005862
Name:NUGENT FAMILY COUNSELING CENTER INC.
Entity Type:Organization
Organization Name:NUGENT FAMILY COUNSELING CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/LEAD THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:GEOFFREY
Authorized Official - Middle Name:JULIAN
Authorized Official - Last Name:NUGENT
Authorized Official - Suffix:JR
Authorized Official - Credentials:LMFT, LPCC, PHD
Authorized Official - Phone:408-341-9222
Mailing Address - Street 1:950 S BASCOM AVE
Mailing Address - Street 2:SUITE 2005
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-3536
Mailing Address - Country:US
Mailing Address - Phone:408-341-9222
Mailing Address - Fax:
Practice Address - Street 1:950 S BASCOM AVE STE 2010
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-3538
Practice Address - Country:US
Practice Address - Phone:408-341-9222
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-28
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CA47549106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty