Healthcare Provider Details

I. General information

NPI: 1346073848
Provider Name (Legal Business Name): RELATIONSHIPS, A MARRIAGE, FAMILY THERAPY AND EDUCATIONAL PSYCHOLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2024
Last Update Date: 08/21/2024
Certification Date: 08/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

605 TENNANT AVE STE G
MORGAN HILL CA
95037-5529
US

IV. Provider business mailing address

15425 OAK GLEN AVE
MORGAN HILL CA
95037-8802
US

V. Phone/Fax

Practice location:
  • Phone: 408-415-0267
  • Fax: 408-321-0333
Mailing address:
  • Phone: 408-203-4401
  • Fax: 408-351-0333

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 Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: MR. JEFFREY EUGENE BETTENCOURT
Title or Position: CEO AND PRESIDENT
Credential: LMFT, LPCC, LEP
Phone: 408-415-0267