MEDICARE: DAMOOSE MARRIAGE & FAMILY THERAPY, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist

General Provider Information

NPI Number	:	1043178767
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DAMOOSE MARRIAGE & FAMILY THERAPY, INC.

Provider Business Mailing Address
First Line	:	4435 TRIAS ST
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92103-1142
Country	:	US
Telephone Number	:	760-492-3022
Fax Number	:	760-492-3022

Provider Business Practice Location Address
First Line	:	1527 W LEWIS ST
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92103-1220
Country	:	US
Telephone Number	:	760-492-3022
Fax Number	:	760-492-3022

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	LINDSAY DAMOOSE
Credential	:	LMFT
Telephone Number	:	760-492-3022

Provider Enumeration Date	:	01/12/2026
Last Update Date	:	01/12/2026

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