Healthcare Provider Details

I. General information

NPI: 1467091793
Provider Name (Legal Business Name): FAMILY TREE WELLNESS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2020
Last Update Date: 11/15/2021
Certification Date: 11/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

46 N 2ND ST
CAMPBELL CA
95008-2026
US

IV. Provider business mailing address

46 N 2ND ST
CAMPBELL CA
95008-2026
US

V. Phone/Fax

Practice location:
  • Phone: 408-345-5572
  • Fax:
Mailing address:
  • Phone: 408-345-5572
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: JESSICA SORCI
Title or Position: FOUNDING DIRECTOR
Credential: LMFT
Phone: 408-345-5572