Provider Demographics
NPI:1750932810
Name:WOMENS THERAPY INSTITUTE, MARRIAGE AND FAMILY THERAPY CORPORATION
Entity type:Organization
Organization Name:WOMENS THERAPY INSTITUTE, MARRIAGE AND FAMILY THERAPY CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MABEL
Authorized Official - Middle Name:
Authorized Official - Last Name:YIU
Authorized Official - Suffix:
Authorized Official - Credentials:MFT
Authorized Official - Phone:650-272-0388
Mailing Address - Street 1:825 SAN ANTONIO RD STE 104
Mailing Address - Street 2:
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94303-4620
Mailing Address - Country:US
Mailing Address - Phone:650-285-1909
Mailing Address - Fax:
Practice Address - Street 1:825 SAN ANTONIO RD STE 104
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94303-4620
Practice Address - Country:US
Practice Address - Phone:650-285-1909
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-20
Last Update Date:2019-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1487137113Medicaid
CA1033469937Medicaid
CA1114330230Medicaid
CA1316342322Medicaid
CA1568800530Medicaid
CA1104387844Medicaid
CA1932357589Medicaid