Provider Demographics
NPI:1912433434
Name:BAY AREA MARRIAGE AND FAMILY THERAPY & COACHING, INC.
Entity Type:Organization
Organization Name:BAY AREA MARRIAGE AND FAMILY THERAPY & COACHING, INC.
Other - Org Name:ENGLE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:ENGLE
Authorized Official - Suffix:
Authorized Official - Credentials:MA, MFT, RDT
Authorized Official - Phone:510-564-9700
Mailing Address - Street 1:340 S LEMON AVENUE
Mailing Address - Street 2:PMB 8764
Mailing Address - City:WALNUT
Mailing Address - State:CA
Mailing Address - Zip Code:91789
Mailing Address - Country:US
Mailing Address - Phone:510-564-9700
Mailing Address - Fax:
Practice Address - Street 1:1265 65TH ST
Practice Address - Street 2:
Practice Address - City:EMERYVILLE
Practice Address - State:CA
Practice Address - Zip Code:94608
Practice Address - Country:US
Practice Address - Phone:510-796-2000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-03
Last Update Date:2018-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA81850106H00000X
CA103949106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty