MEDICARE: MARRIAGE AND FAMILY THERAPY COLLABORATIVE A PROFESSIONAL CORPORATION

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1538675525
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARRIAGE AND FAMILY THERAPY COLLABORATIVE A PROFESSIONAL CORPORATION

Provider Business Mailing Address
First Line	:	545 MERIDIAN AVENUE
Second Line	:	STE. D #28233
City	:	SAN JOSE
State	:	CA
Zip	:	95126-6618
Country	:	US
Telephone Number	:	408-207-5269
Fax Number	:

Provider Business Practice Location Address
First Line	:	1570 THE ALAMEDA STE 319
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95126-2305
Country	:	US
Telephone Number	:	408-207-5269
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	TRICIA JORDAN MLNARIK
Credential	:	MA
Telephone Number	:	408-207-5269

Provider Enumeration Date	:	12/28/2017
Last Update Date	:	03/08/2024

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