Provider Demographics
NPI:1821649278
Name:SOUTH BAY FAMILY THERAPY, INC.
Entity Type:Organization
Organization Name:SOUTH BAY FAMILY THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ELEANOR
Authorized Official - Middle Name:
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:408-659-6887
Mailing Address - Street 1:17705 HALE AVE STE F4
Mailing Address - Street 2:
Mailing Address - City:MORGAN HILL
Mailing Address - State:CA
Mailing Address - Zip Code:95037-4349
Mailing Address - Country:US
Mailing Address - Phone:408-659-6887
Mailing Address - Fax:408-776-1901
Practice Address - Street 1:17705 HALE AVE STE F4
Practice Address - Street 2:
Practice Address - City:MORGAN HILL
Practice Address - State:CA
Practice Address - Zip Code:95037-4349
Practice Address - Country:US
Practice Address - Phone:408-659-6887
Practice Address - Fax:408-776-1901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-26
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No251S00000XAgenciesCommunity/Behavioral Health