MEDICARE: PACIFIC BEACH MARRIAGE AND FAMILY COUNSELING, 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	106H00000X	Marriage & Family Therapist	MFT#24460	CA

General Provider Information

NPI Number	:	1548476708
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PACIFIC BEACH MARRIAGE AND FAMILY COUNSELING, INC.

Provider Business Mailing Address
First Line	:	1010 TURQUOISE ST STE 265
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92109-1200
Country	:	US
Telephone Number	:	858-488-5732
Fax Number	:	858-273-8517

Provider Business Practice Location Address
First Line	:	1010 TURQUOISE ST STE 265
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92109-1200
Country	:	US
Telephone Number	:	858-488-5732
Fax Number	:	858-273-8517

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. DAVID MARTIN HENDRICK
Credential	:	M.S.
Telephone Number	:	858-488-5732

Provider Enumeration Date	:	05/15/2007
Last Update Date	:	08/22/2020

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