Healthcare Provider Details

I. General information

NPI: 1093342693
Provider Name (Legal Business Name): ANISSA BELL MARRIAGE & FAMILY THERAPY, PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2020
Last Update Date: 03/24/2020
Certification Date: 03/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12526 HIGH BLUFF DR STE 300
SAN DIEGO CA
92130-2067
US

IV. Provider business mailing address

12526 HIGH BLUFF DR STE 300
SAN DIEGO CA
92130-2067
US

V. Phone/Fax

Practice location:
  • Phone: 858-400-4646
  • Fax: 858-480-7234
Mailing address:
  • Phone: 858-400-4646
  • Fax: 858-480-7234

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 Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: ANISSA BELL
Title or Position: CEO
Credential: LMFT
Phone: 858-400-4646