| Derose Marriage And Family Therapy Corporation | |
|
1026 Palm St Ste 215 San Luis Obispo CA 93401-3260 | |
| (805) 242-1375 | |
| Not Available |
| Full Name | Derose Marriage And Family Therapy Corporation |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 1026 Palm St Ste 215, San Luis Obispo, California |
| Authorized Official Name and Position | Leah Lorraine Derose (CEO) |
| Authorized Official Contact | 8052421375 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Derose Marriage And Family Therapy Corporation 1026 Palm St Ste 215 San Luis Obispo CA 93401-3260 Ph: (805) 242-1375 | Derose Marriage And Family Therapy Corporation 1026 Palm St Ste 215 San Luis Obispo CA 93401-3260 Ph: (805) 242-1375 |
| NPI Number | 1588249676 |
|---|---|
| Provider Enumeration Date | 03/10/2021 |
| Last Update Date | 03/10/2021 |
| Certification Date | 03/08/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1588249676 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
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