Provider Demographics
NPI:1386904811
Name:FOLTZ, TATYANA ALEXIS (MSW)
Entity type:Individual
Prefix:
First Name:TATYANA
Middle Name:ALEXIS
Last Name:FOLTZ
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2065
Mailing Address - Street 2:
Mailing Address - City:BURLINGAME
Mailing Address - State:CA
Mailing Address - Zip Code:94011-2065
Mailing Address - Country:US
Mailing Address - Phone:650-550-4082
Mailing Address - Fax:650-993-8723
Practice Address - Street 1:820 STANTON RD
Practice Address - Street 2:# 2065
Practice Address - City:BURLINGAME
Practice Address - State:CA
Practice Address - Zip Code:94011-8263
Practice Address - Country:US
Practice Address - Phone:650-550-4082
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-17
Last Update Date:2013-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32588101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health