Healthcare Provider Details

I. General information

NPI: 1164028007
Provider Name (Legal Business Name): MIYOUNG SON MARRIAGE FAMILY THERAPY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2020
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4196 OCEANSIDE BLVD STE B
OCEANSIDE CA
92056-6010
US

IV. Provider business mailing address

4196 OCEANSIDE BLVD STE B
OCEANSIDE CA
92056-6010
US

V. Phone/Fax

Practice location:
  • Phone: 323-452-1955
  • Fax: 619-701-6657
Mailing address:
  • Phone: 323-452-1955
  • Fax: 619-701-6657

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MS. MIYOUNG SON
Title or Position: CEO
Credential: MA
Phone: 323-452-1955