| Mindful Evolution Family Therapy Inc | |
|
4475 Mission Blvd Ste 201 San Diego CA 92109-3967 | |
| (760) 822-9946 | |
| Not Available |
| Full Name | Mindful Evolution Family Therapy Inc |
|---|---|
| Speciality | Marriage & Family Therapist |
| Location | 4475 Mission Blvd Ste 201, San Diego, California |
| Authorized Official Name and Position | Jessica Martin (OWNER/ THERAPIST) |
| Authorized Official Contact | 7608229946 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mindful Evolution Family Therapy Inc 4475 Mission Blvd Ste 201 San Diego CA 92109-3967 Ph: () - | Mindful Evolution Family Therapy Inc 4475 Mission Blvd Ste 201 San Diego CA 92109-3967 Ph: (760) 822-9946 |
| NPI Number | 1932815255 |
|---|---|
| Provider Enumeration Date | 01/30/2023 |
| Last Update Date | 01/30/2023 |
| Certification Date | 01/30/2023 |
| Medicare PECOS PAC ID | 9830541911 |
|---|---|
| Medicare Enrollment ID | O20240115001543 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1932815255 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 106H00000X | Marriage & Family Therapist | (* (Not Available)) | Primary |
| Provider Name | Jessica Allyssa Martin |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1669037883 PECOS PAC ID: 0749632826 Enrollment ID: I20240115001552 |
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