| An Individual Marriage And Relationship Therapy Corporation | |
|
1015 Shoreline Dr San Mateo CA 94404-2047 | |
| (650) 762-5284 | |
| Not Available |
| Full Name | An Individual Marriage And Relationship Therapy Corporation |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 1015 Shoreline Dr, San Mateo, California |
| Authorized Official Name and Position | Jeanne Peri Sutton (CEO/OWNER) |
| Authorized Official Contact | 6507625284 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| An Individual Marriage And Relationship Therapy Corporation 1015 Shoreline Dr San Mateo CA 94404-2047 Ph: (410) 459-5024 | An Individual Marriage And Relationship Therapy Corporation 1015 Shoreline Dr San Mateo CA 94404-2047 Ph: (650) 762-5284 |
| NPI Number | 1225765787 |
|---|---|
| Provider Enumeration Date | 08/04/2022 |
| Last Update Date | 08/04/2022 |
| Certification Date | 08/04/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1225765787 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
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