| Disruptive Therapy Collective For The Individual, Family, And Child, I | |
|
1769 Park Ave Ste 250 San Jose CA 95126-2030 | |
| (408) 365-4238 | |
| Not Available |
| Full Name | Disruptive Therapy Collective For The Individual, Family, And Child, I |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 1769 Park Ave Ste 250, San Jose, California |
| Authorized Official Name and Position | Alice Bui (CEO) |
| Authorized Official Contact | 4083654238 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Disruptive Therapy Collective For The Individual, Family, And Child, I 1769 Park Ave Ste 250 San Jose CA 95126-2030 Ph: (408) 365-4238 | Disruptive Therapy Collective For The Individual, Family, And Child, I 1769 Park Ave Ste 250 San Jose CA 95126-2030 Ph: (408) 365-4238 |
| NPI Number | 1083392302 |
|---|---|
| Provider Enumeration Date | 07/06/2023 |
| Last Update Date | 07/06/2023 |
| Certification Date | 07/06/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1083392302 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
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