Healthcare Provider Details

I. General information

NPI: 1134083546
Provider Name (Legal Business Name): MOOD MARRIAGE AND FAMILY THERAPY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2025
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2150 PALOMAR AIRPT RD STE 209
CARLSBAD CA
92011-4408
US

IV. Provider business mailing address

2150 PALOMAR AIRPT RD STE 209
CARLSBAD CA
92011-4408
US

V. Phone/Fax

Practice location:
  • Phone: 760-237-0050
  • Fax:
Mailing address:
  • Phone: 760-237-0050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: KELLI OLDS
Title or Position: OWNER
Credential: LMFT
Phone: 702-806-4085