Organization
MINDFUL LIVING, A MARRIAGE AND FAMILY THERAPY CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LAURIE PHUONG ERTLEY LMFT (PRESIDENT)
(415) 890-3791
Entity
Organization
Contact information
Practice address
200 GREEN ST STE 200, SAN FRANCISCO, CA 94111-1356
(415) 890-3791
Mailing address
200 GREEN ST STE 200, SAN FRANCISCO, CA 94111-1356
(415) 890-3791
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
85042
BOARD BEHAVIORAL SERVICES
CA
Enumeration date
06/03/2020
Last updated
06/03/2020
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