Basic Information
| Provider Information | |||||||||
| NPI: | 1629373170 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MEJIA | ||||||||
| FirstName: | ANIBAL | ||||||||
| MiddleName: | DANIEL | ||||||||
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| Credential: | LMFT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1035 MARKET ST | ||||||||
| Address2: | SUITE 400 | ||||||||
| City: | SAN FRANCISCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 941031605 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4154878067 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1035 MARKET ST | ||||||||
| Address2: | SUITE 400 | ||||||||
| City: | SAN FRANCISCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 941031605 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4154878067 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/13/2011 | ||||||||
| LastUpdateDate: | 04/20/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 106H00000X | 46192 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist | 101YM0800X | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 171M00000X | N | Other Service Providers | Case Manager/Care Coordinator | 172V00000X | N | Other Service Providers | Community Health Worker |
No ID Information.