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General NPI Number Information
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NPI Number | 1801755269
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Entity Type | Organization
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Legal Business Name | MY NICHE FAMILY THERAPY PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 01/20/2026
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Last Update Date | 01/20/2026
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Provider Practice Location Address
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Address Line | 825 WEBSTER ST STE B
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City | FAIRFIELD
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State | CA
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Zip | 94533-5522
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Country | US
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Telephone | 707-475-3203
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Fax | 707-439-3037
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Provider Business Mailing Address
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Address Line | 346 ROCKHURST CT
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City | FAIRFIELD
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State | CA
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Zip | 94533-1241
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Country | US
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Telephone | 707-475-3203
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Fax | 707-439-3037
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Authorized Official
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Title or Position | OWNER
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Name | CHARLES THOMAS ANDERSON
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Credential | LMFT
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Telephone | 707-386-8066
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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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