Provider Demographics
NPI:1831200765
Name:YESAIE, TALIN (MFT)
Entity type:Individual
Prefix:MISS
First Name:TALIN
Middle Name:
Last Name:YESAIE
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3002 ARMSTRONG ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92111-5702
Mailing Address - Country:US
Mailing Address - Phone:760-547-2808
Mailing Address - Fax:
Practice Address - Street 1:1640 MAGNOLIA AVE
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92008-2650
Practice Address - Country:US
Practice Address - Phone:760-547-2808
Practice Address - Fax:760-547-2802
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF#49728106H00000X
CAMFC 45648106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist