Provider Demographics
NPI:1780156877
Name:MINDFUL CHILD & FAMILY THERAPY, INC
Entity type:Organization
Organization Name:MINDFUL CHILD & FAMILY THERAPY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JACLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:LONG
Authorized Official - Suffix:
Authorized Official - Credentials:MFT
Authorized Official - Phone:415-533-8012
Mailing Address - Street 1:PO BOX 3156
Mailing Address - Street 2:
Mailing Address - City:HALF MOON BAY
Mailing Address - State:CA
Mailing Address - Zip Code:94019-3156
Mailing Address - Country:US
Mailing Address - Phone:415-533-8012
Mailing Address - Fax:
Practice Address - Street 1:4966 EL CAMINO REAL STE 115
Practice Address - Street 2:
Practice Address - City:LOS ALTOS
Practice Address - State:CA
Practice Address - Zip Code:94022-1406
Practice Address - Country:US
Practice Address - Phone:650-296-2299
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-30
Last Update Date:2018-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty