1376815829 NPI number — COGNITIVE BEHAVIOR THERAPY CENTER ADULT & COUNSELING, INC.

Table of content: DR. ROBERT MARION WHITE MD (NPI 1487653325)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376815829 NPI number — COGNITIVE BEHAVIOR THERAPY CENTER ADULT & COUNSELING, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COGNITIVE BEHAVIOR THERAPY CENTER ADULT & COUNSELING, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1376815829
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/18/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
900 E. HAMILTON AVE,
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
CAMPBELL
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95008
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
408-384-8404
Provider Business Mailing Address Fax Number:
408-608-0484

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
900 E. HAMILTON AVE,
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
CAMPBELL
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95008
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
408-384-8404
Provider Business Practice Location Address Fax Number:
408-608-0484
Provider Enumeration Date:
01/30/2012

Additional Information

Authorized Official

Authorized Official Last Name:
JOHNSON
Authorized Official First Name:
LAURA
Authorized Official Middle Name:
LC
Authorized Official Title or Position:
CENTER DIRECTOR/OWNER
Authorized Official Telephone Number:
408-384-8404

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X , with the licence number:  MFC-48807 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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