# CHILD THERAPY INSTITUTE OF MARIN

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1821633348
- **Authorized official:** SHERIE SHUGHART (ADMINISTRATIVE ASSISTANT)
- **Authorized official phone:** (415) 456-7724

## Contact information

- **Practice address:** 558 SAN ANSELMO AVE, SAN ANSELMO, CA 94960-2621
- **Practice address phone:** (415) 456-7724
- **Practice address fax:** (415) 456-1050
- **Mailing address:** 1480 LINCOLN AVE STE 8, SAN RAFAEL, CA 94901-2085

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 106H00000X | Marriage & Family Therapist | — | NULL | Yes |
| 106H00000X | Marriage & Family Therapist | — | — | Yes |

## Other

- **Enumeration date:** 11/07/2019
- **Last updated:** 11/07/2019