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General NPI Number Information
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NPI Number | 1780156877
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Entity Type | Organization
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Legal Business Name | MINDFUL CHILD & FAMILY THERAPY, INC
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Dates
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Enumeration Date | 12/30/2018
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Last Update Date | 12/30/2018
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Provider Practice Location Address
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Address Line | 4966 EL CAMINO REAL STE 115
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City | LOS ALTOS
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State | CA
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Zip | 94022-1406
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Country | US
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Telephone | 650-296-2299
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 3156
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City | HALF MOON BAY
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State | CA
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Zip | 94019-3156
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Country | US
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Telephone | 415-533-8012
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | JACLYN LONG
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Credential | MFT
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Telephone | 415-533-8012
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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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