| Mindful Child & Family Therapy, Inc | |
|
4966 El Camino Real Ste 115 Los Altos CA 94022-1406 | |
| (650) 296-2299 | |
| Not Available |
| Full Name | Mindful Child & Family Therapy, Inc |
|---|---|
| Speciality | Marriage & Family Therapist |
| Location | 4966 El Camino Real Ste 115, Los Altos, California |
| Authorized Official Name and Position | Jaclyn Long (DIRECTOR) |
| Authorized Official Contact | 4155338012 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mindful Child & Family Therapy, Inc Po Box 3156 Half Moon Bay CA 94019-3156 Ph: (415) 533-8012 | Mindful Child & Family Therapy, Inc 4966 El Camino Real Ste 115 Los Altos CA 94022-1406 Ph: (650) 296-2299 |
| NPI Number | 1780156877 |
|---|---|
| Provider Enumeration Date | 12/30/2018 |
| Last Update Date | 12/30/2018 |
| Medicare PECOS PAC ID | 8820449945 |
|---|---|
| Medicare Enrollment ID | O20240112001347 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1780156877 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 106H00000X | Marriage & Family Therapist | (* (Not Available)) | Primary |
| Provider Name | Jaclyn Kelly Long |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1871065961 PECOS PAC ID: 0648621763 Enrollment ID: I20240112001585 |
| Provider Name | Linda Pace Meyer |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1578195350 PECOS PAC ID: 3375995350 Enrollment ID: I20240115001839 |
| Provider Name | Lisa Macias |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1407231434 PECOS PAC ID: 3375996416 Enrollment ID: I20240125001247 |
| Provider Name | Lakshmi Madhavi Kalluri |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1215609417 PECOS PAC ID: 0749633709 Enrollment ID: I20240126000969 |
| Provider Name | Jennifer Lynn Merrill |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1003111048 PECOS PAC ID: 5496108276 Enrollment ID: I20240129001040 |
| Provider Name | Jalene Michele Nardella |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1952479347 PECOS PAC ID: 9234577891 Enrollment ID: I20240402003636 |
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