=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316647480
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MARRIAGE & FAMILY THERAPY FOR PEACE OF MIND CORPORATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/07/2023
-----------------------------------------------------
Last Update Date | 05/18/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 874 57TH ST
-----------------------------------------------------
City | SACRAMENTO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95819-3327
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 916-477-4494
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3705 DAYTON ST
-----------------------------------------------------
City | SACRAMENTO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95838-3920
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 916-477-4494
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | FOUNDER
-----------------------------------------------------
Name | ROBERT AUSTIN NGANGA
-----------------------------------------------------
Credential | LMFT
-----------------------------------------------------
Telephone | 916-477-4494
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------