Healthcare Provider Details

I. General information

NPI: 1952214892
Provider Name (Legal Business Name): THE INTENTFUL LIFE MARRIAGE AND FAMILY THERAPY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2026
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13029 DANIELSON ST STE 130
POWAY CA
92064-8854
US

IV. Provider business mailing address

13029 DANIELSON ST STE 130
POWAY CA
92064-8854
US

V. Phone/Fax

Practice location:
  • Phone: 619-346-3996
  • Fax:
Mailing address:
  • Phone: 619-346-3996
  • 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: IMAYA STEVENS
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: LMFT
Phone: 619-346-3996