Provider Demographics
NPI:1447081153
Name:THE CENTER FOR PSYCHOLOGICAL AND PSYCHEDELIC FAMI
Entity type:Organization
Organization Name:THE CENTER FOR PSYCHOLOGICAL AND PSYCHEDELIC FAMI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LMFT, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:STUBBLEFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:MS LMFT81059
Authorized Official - Phone:949-500-9513
Mailing Address - Street 1:242 W MAIN ST STE 104
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-7715
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:242 W MAIN ST STE 104
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-7715
Practice Address - Country:US
Practice Address - Phone:949-705-9811
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-13
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty