Provider Demographics
NPI:1053010728
Name:PACIFIC PSYCHOTHERAPY MARRIAGE AND FAMILY THERAPY CORPORATION PC
Entity type:Organization
Organization Name:PACIFIC PSYCHOTHERAPY MARRIAGE AND FAMILY THERAPY CORPORATION PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPY
Authorized Official - Prefix:
Authorized Official - First Name:HAROLD
Authorized Official - Middle Name:CONNOR
Authorized Official - Last Name:MOSS
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:831-204-0131
Mailing Address - Street 1:3121 PARK AVE STE F
Mailing Address - Street 2:
Mailing Address - City:SOQUEL
Mailing Address - State:CA
Mailing Address - Zip Code:95073-2956
Mailing Address - Country:US
Mailing Address - Phone:831-204-0131
Mailing Address - Fax:
Practice Address - Street 1:3121 PARK AVE STE F
Practice Address - Street 2:
Practice Address - City:SOQUEL
Practice Address - State:CA
Practice Address - Zip Code:95073-2956
Practice Address - Country:US
Practice Address - Phone:831-204-0131
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-01
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty