Provider Demographics
NPI:1154897221
Name:CHOSEN FAMILY THERAPY PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:CHOSEN FAMILY THERAPY PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JS
Authorized Official - Middle Name:
Authorized Official - Last Name:VERY
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:707-509-8659
Mailing Address - Street 1:PO BOX 1248
Mailing Address - Street 2:
Mailing Address - City:MENDOCINO
Mailing Address - State:CA
Mailing Address - Zip Code:95460-1248
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1231 MARKET ST STE 810
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94103-1400
Practice Address - Country:US
Practice Address - Phone:707-509-8659
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-16
Last Update Date:2018-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty