Provider Demographics
NPI:1174059687
Name:MINDFUL GUIDES, A MARRIAGE AND FAMILY THERAPY CORPORATION
Entity type:Organization
Organization Name:MINDFUL GUIDES, A MARRIAGE AND FAMILY THERAPY CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, LICENSED MFT
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:KAHN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:858-442-5548
Mailing Address - Street 1:7734 HERSCHEL AVE
Mailing Address - Street 2:SUITE O
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-4433
Mailing Address - Country:US
Mailing Address - Phone:858-442-5548
Mailing Address - Fax:
Practice Address - Street 1:7734 HERSCHEL AVE
Practice Address - Street 2:SUITE O
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-4433
Practice Address - Country:US
Practice Address - Phone:858-442-5548
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-03
Last Update Date:2017-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA42737106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty