| Parent School | |
|
145 Esperanza St Tiburon CA 94920-1914 | |
| (415) 233-6866 | |
| Not Available |
| Full Name | Parent School |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 145 Esperanza St, Tiburon, California |
| Authorized Official Name and Position | Polly Stark Ely (PRESIDENT) |
| Authorized Official Contact | 4152336866 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Parent School Po Box 685 Tiburon CA 94920-0685 Ph: (415) 233-6866 | Parent School 145 Esperanza St Tiburon CA 94920-1914 Ph: (415) 233-6866 |
| NPI Number | 1609339811 |
|---|---|
| Provider Enumeration Date | 04/13/2019 |
| Last Update Date | 01/23/2021 |
| Certification Date | 01/23/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1609339811 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| 261QM0850X | Clinic/center - Adult Mental Health | (* (Not Available)) | Secondary |
Andrea Shelley, Clinical & Forensic Psychology, A Professional Corpora Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 1832 Centro West St, Tiburon, CA 94920 Phone: 415-515-3211 |