Provider Demographics
NPI:1841452752
Name:THE MARRIAGE ENRICHMENT CTR
Entity type:Organization
Organization Name:THE MARRIAGE ENRICHMENT CTR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:SPRING
Authorized Official - Suffix:
Authorized Official - Credentials:RN MSN
Authorized Official - Phone:415-456-4944
Mailing Address - Street 1:PO BOX 1474
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94915
Mailing Address - Country:US
Mailing Address - Phone:415-456-4944
Mailing Address - Fax:
Practice Address - Street 1:817 D STREET
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901
Practice Address - Country:US
Practice Address - Phone:415-456-4944
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-01
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
CARN224287106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty