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General NPI Number Information
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NPI Number | 1437860236
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Entity Type | Organization
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Legal Business Name | SOMA PSYCH FAMILY THERAPY, INC.
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Dates
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Enumeration Date | 12/12/2022
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Last Update Date | 12/12/2022
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Provider Practice Location Address
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Address Line | 2021 SPERRY AVE STE 20
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City | VENTURA
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State | CA
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Zip | 93003-7446
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Country | US
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Telephone | 760-459-9790
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Fax |
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Provider Business Mailing Address
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Address Line | 85 PONIU CIR
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City | WAILUKU
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State | HI
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Zip | 96793-2906
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Country | US
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Telephone | 760-459-9790
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Fax |
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER (CEO)
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Name | MARTENA RACHEL WILSON
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Credential |
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Telephone | 760-459-9790
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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