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General NPI Number Information
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NPI Number | 1912433434
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Entity Type | Organization
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Legal Business Name | BAY AREA MARRIAGE AND FAMILY THERAPY & COACHING, INC.
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Dates
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Enumeration Date | 05/03/2017
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Last Update Date | 07/31/2018
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Provider Practice Location Address
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Address Line | 1265 65TH ST
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City | EMERYVILLE
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State | CA
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Zip | 94608
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Country | US
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Telephone | 510-796-2000
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Fax |
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Provider Business Mailing Address
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Address Line | 340 S LEMON AVENUE PMB 8764
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City | WALNUT
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State | CA
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Zip | 91789
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Country | US
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Telephone | 510-564-9700
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | MS. JESSICA ANNE ENGLE
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Credential | MA, MFT, RDT
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Telephone | 510-564-9700
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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 | 103949
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 81850
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License Number State | CA
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