Provider Demographics
NPI:1538912688
Name:BEACON FAMILY THERAPY, PROF. CORP.
Entity type:Organization
Organization Name:BEACON FAMILY THERAPY, PROF. CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:TUCK
Authorized Official - Last Name:KUEBLER
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LMFT
Authorized Official - Phone:858-722-2442
Mailing Address - Street 1:9340 CARMEL MOUNTAIN RD STE F
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92129-2161
Mailing Address - Country:US
Mailing Address - Phone:858-722-2442
Mailing Address - Fax:
Practice Address - Street 1:9340 CARMEL MOUNTAIN RD STE F
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92129-2161
Practice Address - Country:US
Practice Address - Phone:858-722-2442
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-09
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty