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General NPI Number Information
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NPI Number | 1326785361
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Entity Type | Organization
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Legal Business Name | CONSCIOUS MARRIAGE AND FAMILY THERAPY, INC.
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Dates
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Enumeration Date | 05/19/2022
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Last Update Date | 09/13/2022
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Provider Practice Location Address
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Address Line | 2108 N ST STE N
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City | SACRAMENTO
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State | CA
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Zip | 95816-5712
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Country | US
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Telephone | 619-393-2290
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Fax |
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Provider Business Mailing Address
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Address Line | 1140 WALL ST # 355
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City | LA JOLLA
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State | CA
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Zip | 92037-4531
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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
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Name | SU BOUDREAU
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Credential |
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Telephone | 619-393-2290
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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