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General NPI Number Information
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NPI Number | 1205657392
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Entity Type | Organization
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Legal Business Name | MOTHERTHRIVE THERAPY CORP
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Dates
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Enumeration Date | 10/21/2024
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Last Update Date | 10/21/2024
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Provider Practice Location Address
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Address Line | 5837 JEFFRIES RANCH RD
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City | OCEANSIDE
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State | CA
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Zip | 92057-4848
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Country | US
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Telephone | 661-373-4688
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Fax |
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Provider Business Mailing Address
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Address Line | 825 COLLEGE BLVD STE 102 PMB 1005
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City | OCEANSIDE
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State | CA
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Zip | 92057
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER AND THERAPIST
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Name | JENNIFER MENDOZA
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Credential | LCSW, PMH-C
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Telephone | 661-373-4688
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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