Provider Demographics
NPI:1205581626
Name:HIEDI CHAN MARRIAGE AND FAMILY THERAPY INCORPORATED
Entity type:Organization
Organization Name:HIEDI CHAN MARRIAGE AND FAMILY THERAPY INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:HIEDI
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:858-945-4241
Mailing Address - Street 1:13037 YERBA VALLEY WAY
Mailing Address - Street 2:
Mailing Address - City:LAKESIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92040-1567
Mailing Address - Country:US
Mailing Address - Phone:858-945-4241
Mailing Address - Fax:
Practice Address - Street 1:3160 CAMINO DEL RIO S STE 116
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-8933
Practice Address - Country:US
Practice Address - Phone:858-381-0310
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-14
Last Update Date:2022-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty