Provider Demographics
NPI:1184486946
Name:INVISIBLE WOMB HOLISTIC & INTEGRATIVE MARRIAGE & FAMILY THERAPY, INC
Entity type:Organization
Organization Name:INVISIBLE WOMB HOLISTIC & INTEGRATIVE MARRIAGE & FAMILY THERAPY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JETAUN
Authorized Official - Middle Name:G
Authorized Official - Last Name:MILLS
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:510-423-3493
Mailing Address - Street 1:836 SOUTHAMPTON RD # 228
Mailing Address - Street 2:
Mailing Address - City:BENICIA
Mailing Address - State:CA
Mailing Address - Zip Code:94510-1961
Mailing Address - Country:US
Mailing Address - Phone:510-423-3493
Mailing Address - Fax:707-261-0754
Practice Address - Street 1:250 PANORAMA DR
Practice Address - Street 2:
Practice Address - City:BENICIA
Practice Address - State:CA
Practice Address - Zip Code:94510-1523
Practice Address - Country:US
Practice Address - Phone:510-423-3493
Practice Address - Fax:707-261-0754
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-26
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty