Provider Demographics
NPI:1922873694
Name:SOMA PSYCH FOUNDATION CENTER INC
Entity Type:Organization
Organization Name:SOMA PSYCH FOUNDATION CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARTENA
Authorized Official - Middle Name:
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:760-459-9790
Mailing Address - Street 1:2021 SPERRY AVE STE 20
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-7446
Mailing Address - Country:US
Mailing Address - Phone:760-459-9790
Mailing Address - Fax:
Practice Address - Street 1:2021 SPERRY AVE STE 20
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-7446
Practice Address - Country:US
Practice Address - Phone:760-459-9790
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-22
Last Update Date:2023-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No251S00000XAgenciesCommunity/Behavioral Health