=====================================================
General NPI Number Information
=====================================================
NPI Number | 1295621639
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PAUL SLATTERY LICENSED MARRIAGE AND FAMILY THERAPIST AND ASSOCIATES INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/13/2025
-----------------------------------------------------
Last Update Date | 06/13/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1303 SAN CARLOS AVE
-----------------------------------------------------
City | SAN CARLOS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94070-2317
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 650-761-1956
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1146 MASON DR
-----------------------------------------------------
City | PACIFICA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94044-3610
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 650-761-1956
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | PAUL STEVEN SLATTERY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 650-761-1956
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------