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Bay Area Mhc Psychology Pc

NPI Registration Record

Provider / OrganizationNPIDate Certified
BAY AREA MHC PSYCHOLOGY PC16397964022020-06-28
Other Names:
Entity TypeOrganization
Provider OrganizationBAY AREA MHC PSYCHOLOGY PC
Practice Office Address21 TAMAL VISTA BLVD STE 162
CORTE MADERA, CA US
Practice Office Telephone4152337990
Mailing Address21 TAMAL VISTA BLVD STE 162
CORTE MADERA, CA 949251146 US
Authorized OfficialNICOLAS CHU, CO-DIRECTOR
4152337990
HPT Codes
CodeLicense NoState
103TC0700X PRIMARY
193200000X MULTGroup Code
OPI Codes
Governmental Registrations [CAGE/NCAGE/DUNS]

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