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General NPI Number Information
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NPI Number | 1114699006
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Entity Type | Organization
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Legal Business Name | EBB AND FLOW MARRIAGE AND FAMILY THERAPIST, INC.
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Dates
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Enumeration Date | 09/29/2021
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Last Update Date | 09/29/2021
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Provider Practice Location Address
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Address Line | 2535 CAMINO DEL RIO S STE 220
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City | SAN DIEGO
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State | CA
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Zip | 92108-3756
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Country | US
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Telephone | 619-780-4242
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Fax | 858-777-9676
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Provider Business Mailing Address
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Address Line | 2535 CAMINO DEL RIO S STE 220
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City | SAN DIEGO
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State | CA
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Zip | 92108-3756
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Country | US
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Telephone | 619-780-4242
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Fax | 858-777-9676
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER, FOUNDER
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Name | MR. KYLE ANDREW LEWIS
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Credential | LMFT, LPCC
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Telephone | 619-780-4242
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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