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General NPI Number Information
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NPI Number | 1891452595
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Entity Type | Organization
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Legal Business Name | MAXWELL FAMILY THERAPY SERVICES, INC
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Dates
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Enumeration Date | 11/17/2021
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Last Update Date | 11/17/2021
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Provider Practice Location Address
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Address Line | 2851 CAMINO DEL RIO S STE 300
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City | SAN DIEGO
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State | CA
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Zip | 92108-3814
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Country | US
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Telephone | 619-664-4606
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Fax |
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Provider Business Mailing Address
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Address Line | 2851 CAMINO DEL RIO S STE 300
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City | SAN DIEGO
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State | CA
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Zip | 92108-3814
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Country | US
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Telephone | 619-664-4606
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. MARK MAXWELL
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Credential | PSYD, LMFT #80504
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Telephone | 619-664-4606
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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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