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General NPI Number Information
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NPI Number | 1629692397
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Entity Type | Organization
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Legal Business Name | TLC FAMILY THERAPY CORP
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Dates
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Enumeration Date | 05/29/2020
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Last Update Date | 05/25/2021
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Provider Practice Location Address
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Address Line | 5405 MOREHOUSE DR STE 120
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City | SAN DIEGO
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State | CA
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Zip | 92121-4723
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Country | US
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Telephone | 442-777-2040
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Fax | 858-408-4494
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Provider Business Mailing Address
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Address Line | 5965 VILLAGE WAY. SUITE 105 #112
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City | SAN DIEGO
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State | CA
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Zip | 92130
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Country | US
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Telephone | 442-777-2040
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Fax | 858-408-4494
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Authorized Official
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Title or Position | FOUNDER/CLINICAL DIRECTOR
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Name | TRACEY LYNN CHESTER
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Credential | LMFT
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Telephone | 858-531-3795
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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