Provider Demographics
NPI:1124176615
Name:MILL VALLEY PERFORMANCE CONSULTING GROUP, INC.
Entity type:Organization
Organization Name:MILL VALLEY PERFORMANCE CONSULTING GROUP, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:MARY TERESA
Authorized Official - Last Name:JAROSZ
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:415-482-9796
Mailing Address - Street 1:118 AUBURN ST
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94901-5206
Mailing Address - Country:US
Mailing Address - Phone:415-482-9796
Mailing Address - Fax:415-482-9796
Practice Address - Street 1:300 TAMAL PLZ STE 140
Practice Address - Street 2:
Practice Address - City:CORTE MADERA
Practice Address - State:CA
Practice Address - Zip Code:94925-1131
Practice Address - Country:US
Practice Address - Phone:415-482-9796
Practice Address - Fax:415-482-9796
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2010-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS14376101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty