MEDICARE: OPEN CHAIR THERAPY

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1033980248
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OPEN CHAIR THERAPY

Provider Business Mailing Address
First Line	:	3110 CAMINO DEL RIO S STE 220
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92108-3831
Country	:	US
Telephone Number	:	858-356-2661
Fax Number	:

Provider Business Practice Location Address
First Line	:	3110 CAMINO DEL RIO S STE 220
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92108-3831
Country	:	US
Telephone Number	:	858-356-2661
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	GRACE CHARLTON
Credential	:	LPCC
Telephone Number	:	858-356-2661

Provider Enumeration Date	:	01/16/2024
Last Update Date	:	01/16/2024

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Directions to “OPEN CHAIR THERAPY ” Practice Location

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