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General NPI Number Information
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NPI Number | 1174059687
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Entity Type | Organization
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Legal Business Name | MINDFUL GUIDES, A MARRIAGE AND FAMILY THERAPY CORPORATION
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Dates
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Enumeration Date | 05/03/2017
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Last Update Date | 05/03/2017
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Provider Practice Location Address
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Address Line | 7734 HERSCHEL AVE SUITE O
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City | LA JOLLA
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State | CA
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Zip | 92037-4433
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Country | US
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Telephone | 858-442-5548
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Fax |
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Provider Business Mailing Address
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Address Line | 7734 HERSCHEL AVE SUITE O
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City | LA JOLLA
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State | CA
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Zip | 92037-4433
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Country | US
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Telephone | 858-442-5548
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Fax |
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Authorized Official
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Title or Position | OWNER, LICENSED MFT
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Name | NICOLE KAHN
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Credential |
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Telephone | 858-442-5548
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 42737
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License Number State | CA
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