Healthcare Provider Details

I. General information

NPI: 1437069622
Provider Name (Legal Business Name): STL MARRIAGE AND FAMILY THERAPY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

950 S BASCOM AVE STE 103
SAN JOSE CA
95128-3536
US

IV. Provider business mailing address

950 S BASCOM AVE STE 103
SAN JOSE CA
95128-3536
US

V. Phone/Fax

Practice location:
  • Phone: 408-673-1617
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name: SARAH LEVENE
Title or Position: PRESIDENT
Credential: LMFT
Phone: 408-673-1617