Healthcare Provider Details

I. General information

NPI: 1780156877
Provider Name (Legal Business Name): MINDFUL CHILD & FAMILY THERAPY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/30/2018
Last Update Date: 09/07/2026
Certification Date: 09/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

851 FREMONT AVE STE 210
LOS ALTOS CA
94024-5602
US

IV. Provider business mailing address

PO BOX 3156
HALF MOON BAY CA
94019-3156
US

V. Phone/Fax

Practice location:
  • Phone: 650-297-3400
  • Fax: 650-897-1005
Mailing address:
  • Phone: 650-297-3400
  • Fax: 650-897-1005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: STEPHANIE IZZARELLI
Title or Position: ACCOUNT MANAGER
Credential:
Phone: 650-297-3400