Provider Demographics
NPI:1679113765
Name:KRISTINA COPLEY MARRIAGE AND FAMILY THERAPY, INC
Entity Type:Organization
Organization Name:KRISTINA COPLEY MARRIAGE AND FAMILY THERAPY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:KRISTINA
Authorized Official - Middle Name:SCIARRILLO
Authorized Official - Last Name:COPLEY
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:619-627-1505
Mailing Address - Street 1:1267 ROSECRANS ST STE B
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92106-2692
Mailing Address - Country:US
Mailing Address - Phone:619-627-1505
Mailing Address - Fax:619-393-0754
Practice Address - Street 1:1267 ROSECRANS ST STE B
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92106-2692
Practice Address - Country:US
Practice Address - Phone:619-627-1505
Practice Address - Fax:619-393-0754
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-07
Last Update Date:2020-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health