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General NPI Number Information
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NPI Number | 1689034167
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Entity Type | Organization
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Legal Business Name | MENDING MINDS MENDING HEARTS
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Dates
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Enumeration Date | 02/26/2016
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Last Update Date | 02/26/2016
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Provider Practice Location Address
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Address Line | 6524 44TH ST 208
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City | SACRAMENTO
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State | CA
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Zip | 95823-1265
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Country | US
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Telephone | 916-960-7795
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Fax |
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Provider Business Mailing Address
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Address Line | 1500 W EL CAMINO AVE 464
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City | SACRAMENTO
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State | CA
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Zip | 95833-1945
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Country | US
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Telephone | 916-960-7795
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/PROGRAM DIRECTOR
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Name | GREGORY MORRISON
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Credential | MA
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Telephone | 916-960-7795
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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 | 48768
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License Number State | CA
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