=====================================================
General NPI Number Information
=====================================================
NPI Number | 1609721315
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CINSSA COUNSELING CENTER, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/27/2026
-----------------------------------------------------
Last Update Date | 02/27/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12 GRACELAND DR
-----------------------------------------------------
City | SAN RAFAEL
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94901-1922
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 650-868-9229
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12 GRACELAND DR
-----------------------------------------------------
City | SAN RAFAEL
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94901-1922
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 650-868-9229
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | CINDY JEPSEN
-----------------------------------------------------
Credential | LMFT
-----------------------------------------------------
Telephone | 650-868-9229
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------