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General NPI Number Information
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NPI Number | 1013584473
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Entity Type | Organization
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Legal Business Name | TRAUMA HEALING CENTER MARRIAGE AND FAMILY THERAPY CORP.
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Dates
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Enumeration Date | 06/04/2021
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Last Update Date | 07/27/2021
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Provider Practice Location Address
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Address Line | 1411 MARSH ST STE 201
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City | SAN LUIS OBISPO
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State | CA
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Zip | 93401-2968
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Country | US
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Telephone | 805-703-8870
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Fax |
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Provider Business Mailing Address
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Address Line | 1411 MARSH ST STE 201
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City | SAN LUIS OBISPO
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State | CA
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Zip | 93401-2968
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Country | US
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Telephone | 805-243-0829
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | ELAINE POWER
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Credential | LMFT
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Telephone | 805-243-0829
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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