MEDICARE: BADIS THERAPY LMFT 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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1154138311
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BADIS THERAPY LMFT INC

Provider Business Mailing Address
First Line	:	3441 39TH ST
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92105-3307
Country	:	US
Telephone Number	:	909-219-0274
Fax Number	:

Provider Business Practice Location Address
First Line	:	3441 39TH ST
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92105-3307
Country	:	US
Telephone Number	:	909-219-0274
Fax Number	:	619-209-3092

Authorized Official
Title or Position	:	CEO
Name	:	MR. NICHOLAS W BADIS
Credential	:	LMFT
Telephone Number	:	909-219-0274

Provider Enumeration Date	:	12/11/2024
Last Update Date	:	12/11/2024

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Directions to “BADIS THERAPY LMFT INC ” Practice Location

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