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

Table of content: (NPI 1376815829)

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)





Copyright © 2007-2025 www.npivalidator.com