Provider Demographics
NPI:1427269422
Name:POON, HENRY GC (PHD)
Entity type:Individual
Prefix:
First Name:HENRY
Middle Name:GC
Last Name:POON
Suffix:
Gender:M
Credentials:PHD
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 371013
Mailing Address - Street 2:
Mailing Address - City:MONTARA
Mailing Address - State:CA
Mailing Address - Zip Code:94037-1013
Mailing Address - Country:US
Mailing Address - Phone:415-235-1818
Mailing Address - Fax:
Practice Address - Street 1:122 2ND AVE
Practice Address - Street 2:STE. 212
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94401-3856
Practice Address - Country:US
Practice Address - Phone:415-235-1818
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 35772106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist