Healthcare Provider Details

I. General information

NPI: 1366218919
Provider Name (Legal Business Name): HELLA GOOD THERAPY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/27/2023
Last Update Date: 08/26/2024
Certification Date: 08/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1420 KETTNER BLVD STE 215
SAN DIEGO CA
92101-2421
US

IV. Provider business mailing address

1420 KETTNER BLVD STE 215
SAN DIEGO CA
92101-2421
US

V. Phone/Fax

Practice location:
  • Phone: 858-867-9474
  • Fax:
Mailing address:
  • Phone: 858-867-9474
  • Fax:

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 Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. TEDDIE JACKSON
Title or Position: OWNER
Credential: LMFT
Phone: 858-867-9474