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General NPI Number Information
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NPI Number | 1518754191
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Entity Type | Organization
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Legal Business Name | CENTER FOR MENTAL RESILIENCE, A MARRIAGE AND FAMILY THERAPY CORPORATION
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Dates
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Enumeration Date | 04/24/2025
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Last Update Date | 06/15/2025
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Provider Practice Location Address
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Address Line | 672 W 11TH ST
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City | TRACY
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State | CA
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Zip | 95376-3821
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Country | US
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Telephone | 209-603-6087
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Fax |
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Provider Business Mailing Address
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Address Line | 672 W 11TH ST
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City | TRACY
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State | CA
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Zip | 95376-3821
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Country | US
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Telephone | 209-603-6087
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Fax |
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Authorized Official
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Title or Position | LMFT/CEO
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Name | MATINA TRIGO
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Credential |
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Telephone | 209-603-6087
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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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