Marin Youth Therapy Inc.

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

Legal business name

MARIN YOUTH THERAPY INC.

Doing business as

Marin Youth Therapy

Practice address

101 Meadow Way
San Geronimo, CA 94963

Phone

(707) 834-4078

NPI assigned

Mar 8, 2021

Last updated

Mar 8, 2021By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Kiersten Kotaka, LMFTNPI 1790379766

Title

President

Phone

(707) 834-4078

Specialties & licenses 1

Addresses

Other names 1

• Marin Youth Therapy Doing business as

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Kiersten Kotaka, LMFT 121908

  • Marriage & Family Therapist
  • Corte Madera, CA
  • NPI 1790379766
  NPD Authorized official

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

{
    "created_epoch": "1615161600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1615161600000",
    "number": "1326633702",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 193",
            "city": "SAN GERONIMO",
            "state": "CA",
            "postal_code": "949630193",
            "telephone_number": "707-834-4078"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 MEADOW WAY",
            "city": "SAN GERONIMO",
            "state": "CA",
            "postal_code": "94963",
            "telephone_number": "707-834-4078"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARIN YOUTH THERAPY INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-03-08",
        "last_updated": "2021-03-08",
        "certification_date": "2021-02-17",
        "status": "A",
        "authorized_official_last_name": "KOTAKA",
        "authorized_official_first_name": "KIERSTEN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "707-834-4078",
        "authorized_official_credential": "LMFT"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Marin Youth Therapy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Coastal Health Alliance (Point Reyes Medical Clinic)
• Carolyn Gereau
• Margaret M Gruenke, L.C.S.W.
• Monroe Operations, LLC (Newport Academy-Redwood)
• Traci Prendergast, FNLP, CNFC
• Somatic Family Therapy of Marin, Inc
• Keri Anne Syndulko, LMFT
• Gretchen Zimmermann, RD

• Marriage & Family Therapist in San Geronimo, CA
• Providers in San Geronimo, 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 Mar 8, 2021; 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.