Mark Maxwell, PSY.D, MFT #80504

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

80504 Issued in CA

Practice address

2851 Camino del Rio S Ste 300
San Diego, CA 92108-3814

Phone

(619) 204-9513

NPI assigned

Sep 15, 2016

Last updated

May 28, 2023By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Maxwell Family Therapy Services, Inc

  dba Pacifica Group Counseling and Wellness

  • Marriage & Family Therapist
  • San Diego, CA
  • NPI 1891452595
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1473897600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1685232000000",
    "number": "1205384401",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4334 VOLTAIRE ST",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921071712"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2851 CAMINO DEL RIO S STE 300",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921083814",
            "telephone_number": "619-204-9513"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAXWELL",
        "first_name": "MARK",
        "name_prefix": "Dr.",
        "credential": "PSY.D, MFT #80504",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2016-09-15",
        "last_updated": "2023-05-28",
        "certification_date": "2023-05-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "80504",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Emily Marie Maxwell, PT, DPT
• Kathryn P Maxwell, M.D.
• Kevin John Maxwell, FNP
• Lauren Maxwell
• Luke Darrell Maxwell
• Natasha Sophia Maxwell, M.A., SLP
• Nikolasia Maxwell
• Philip Maxwell
• Rachel Anna Maxwell
• Rebecca Maxwell

• Marriage & Family Therapist in San Diego, CA
• Providers in San Diego, CA by specialty
• Marriage & Family Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 28, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.