Healthcare Provider Details

I. General information

NPI: 1043935653
Provider Name (Legal Business Name): SC MARRIAGE AND FAMILY THERAPY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2022
Last Update Date: 10/06/2022
Certification Date: 10/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2399 AMERICAN RIVER DR
SACRAMENTO CA
95825-7070
US

IV. Provider business mailing address

9500 KIEFER BLVD UNIT 279021
SACRAMENTO CA
95827-4219
US

V. Phone/Fax

Practice location:
  • Phone: 650-241-0709
  • Fax:
Mailing address:
  • Phone: 650-241-0709
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. SEAN CHATMON
Title or Position: CEO/PRESIDENT
Credential: LMFT
Phone: 650-241-0709