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General NPI Number Information
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NPI Number | 1710550918
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Entity Type | Organization
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Legal Business Name | LIFE BY DESIGN MARRIAGE AND FAMILY THERAPY INC
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Dates
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Enumeration Date | 07/23/2021
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Last Update Date | 07/23/2021
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Provider Practice Location Address
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Address Line | 2140 SHATTUCK AVE
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City | BERKELEY
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State | CA
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Zip | 94704-1210
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Country | US
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Telephone | 510-646-0046
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Fax |
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Provider Business Mailing Address
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Address Line | 1611 SYCAMORE AVE UNIT 5511
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City | HERCULES
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State | CA
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Zip | 94547-6021
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Country | US
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Telephone | 510-646-0046
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MELODY WRIGHT
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Credential |
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Telephone | 510-646-0046
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #3
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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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Taxonomy #4
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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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Taxonomy #5
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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