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General NPI Number Information
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NPI Number | 1841927589
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Entity Type | Organization
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Legal Business Name | CLARY SAGE MARRIAGE AND FAMILY THERAPY
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Dates
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Enumeration Date | 08/03/2022
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Last Update Date | 08/03/2022
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Provider Practice Location Address
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Address Line | 205 REYNOLDS DRIVE
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City | BOULDER CREEK
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State | CA
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Zip | 95006
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Country | US
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Telephone | 650-425-3078
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Fax |
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Provider Business Mailing Address
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Address Line | 1700 VAN NESS AVE
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City | SAN FRANCISCO
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State | CA
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Zip | 94109-3621
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Country | US
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Telephone | 650-425-3078
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KIMBERLY MARIE MCGARVEY
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Credential | MFC, LPCC
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Telephone | 650-425-3078
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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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