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15047 Los Gatos Blvd #200 Los Gatos CA 95032-2054 | |
| (408) 364-6799 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Marriage & Family Therapist |
| Location | 15047 Los Gatos Blvd, Los Gatos, California |
| Authorized Official Name and Position | Michael Sullivan (REGIONAL OPERATIONS MANAGER) |
| Authorized Official Contact | 4083646799 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
15047 Los Gatos Blvd. #200 Los Gatos CA 95032 Ph: (408) 364-6799 | 15047 Los Gatos Blvd #200 Los Gatos CA 95032-2054 Ph: (408) 364-6799 |
| NPI Number | 1710433594 |
|---|---|
| Provider Enumeration Date | 08/31/2016 |
| Last Update Date | 08/31/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1710433594 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 106H00000X | Marriage & Family Therapist | LMFT93623 (California) | Primary |
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