NPIMap

Organization Active NPI

Lifemark Marriage & Family Therapy Corporation

  • Marriage & Family Therapist
  • San Diego, CA
National Provider Identifier
1619690401
Registry record updated Sep 26, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Marriage & Family TherapistTaxonomy code 106H00000X
Legal business name
LIFEMARK MARRIAGE & FAMILY THERAPY CORPORATION
Practice address
3819 1St Ave Unit 208
San Diego, CA 92103-3082
Phone
(760) 413-1951
NPI assigned
Sep 26, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 26, 2022

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

Authorized official

Name
Dr. John Michael Evosevich, PHD, LMFTNPI 1619902434
Title
Owner/Ceo
Phone
(760) 413-1951

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Marriage & Family TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 106H00000X Primary

Addresses

Primary practice location

3819 1St Ave Unit 208
San Diego, CA 92103-3082

Mailing address

3819 1St Ave Unit 208
San Diego, CA 92103-3082
Phone (760) 413-1951

Other names 1

  • Lifemark Behavioral Health Doing business as

Electronic endpoints 2

TypeEndpointUseAffiliation
CONNECT URL jm@lifemarkbh.com Direct
CONNECT URL jm@lifemarkbh.com Direct

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1664150400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1664150400000",
    "number": "1619690401",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3819 1ST AVE UNIT 208",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921033082",
            "telephone_number": "760-413-1951"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3819 1ST AVE UNIT 208",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921033082",
            "telephone_number": "760-413-1951"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFEMARK MARRIAGE & FAMILY THERAPY CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-09-26",
        "last_updated": "2022-09-26",
        "certification_date": "2022-09-26",
        "status": "A",
        "authorized_official_last_name": "EVOSEVICH",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "MICHAEL",
        "authorized_official_title_or_position": "OWNER/CEO",
        "authorized_official_telephone_number": "760-413-1951",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD, LMFT"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Marriage & Family Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "jm@lifemarkbh.com",
            "affiliation": "N",
            "endpointDescription": "jm@lifemarkbh.com",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "3819 1st Ave Unit 208",
            "city": "San Diego",
            "state": "CA",
            "country_code": "US",
            "postal_code": "921033082",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "jm@lifemarkbh.com",
            "affiliation": "N",
            "endpointDescription": "jm@lifemarkbh.com",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "3819 1st Ave Unit 208",
            "city": "San Diego",
            "state": "CA",
            "country_code": "US",
            "postal_code": "921033082",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Lifemark Behavioral Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in San Diego, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 2022; 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.