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General NPI Number Information
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NPI Number | 1649011008
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Entity Type | Organization
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Legal Business Name | YELLOW ROSE FAMILY THERAPY
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Dates
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Enumeration Date | 06/01/2024
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Last Update Date | 06/04/2024
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Provider Practice Location Address
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Address Line | 4555 EL CAMINO REAL STE J
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City | ATASCADERO
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State | CA
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Zip | 93422-2700
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Country | US
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Telephone | 805-952-3223
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Fax | 805-703-5539
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Provider Business Mailing Address
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Address Line | 4515 CAYUCOS AVE
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City | ATASCADERO
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State | CA
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Zip | 93422-2707
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Country | US
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Telephone | 805-952-3223
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Fax | 805-703-5539
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Authorized Official
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Title or Position | DIRECTOR
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Name | MONICA BLANDFORD
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Credential | LMFT
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Telephone | 805-952-3223
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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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