Provider Demographics
NPI:1841056454
Name:SOAR MARRIAGE AND FAMILY THERAPY
Entity type:Organization
Organization Name:SOAR MARRIAGE AND FAMILY THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ARTHUR
Authorized Official - Middle Name:DWAIN
Authorized Official - Last Name:TOLBERT
Authorized Official - Suffix:JR
Authorized Official - Credentials:LMFT
Authorized Official - Phone:209-601-2864
Mailing Address - Street 1:140 FEVERFEW ST
Mailing Address - Street 2:
Mailing Address - City:MANTECA
Mailing Address - State:CA
Mailing Address - Zip Code:95337-8622
Mailing Address - Country:US
Mailing Address - Phone:209-679-8203
Mailing Address - Fax:
Practice Address - Street 1:269 WATSON AVE
Practice Address - Street 2:
Practice Address - City:MANTECA
Practice Address - State:CA
Practice Address - Zip Code:95337-5122
Practice Address - Country:US
Practice Address - Phone:209-679-8203
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-22
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1265035406OtherNPI
CA139285OtherLMFT