MEDICARE: AC MARRIAGE AND FAMILY THERAPY INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1013743145
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AC MARRIAGE AND FAMILY THERAPY INC.

Provider Business Mailing Address
First Line	:	PO BOX 26043
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95159-6043
Country	:	US
Telephone Number	:	650-394-7585
Fax Number	:

Provider Business Practice Location Address
First Line	:	717 W JULIAN ST UNIT 345
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95126-2857
Country	:	US
Telephone Number	:	650-394-7585
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ANTWON CHATMON
Credential	:	LMFT
Telephone Number	:	650-394-7585

Provider Enumeration Date	:	09/13/2024
Last Update Date	:	09/13/2024

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