Provider Demographics
NPI:1699946806
Name:WILLOW MARRIAGE FAMILY THERAPIST INC.
Entity type:Organization
Organization Name:WILLOW MARRIAGE FAMILY THERAPIST INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:WILLOW
Authorized Official - Middle Name:M
Authorized Official - Last Name:STERN
Authorized Official - Suffix:
Authorized Official - Credentials:MFT
Authorized Official - Phone:415-298-1292
Mailing Address - Street 1:450 PARK ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ALAMEDA
Mailing Address - State:CA
Mailing Address - Zip Code:94501-6295
Mailing Address - Country:US
Mailing Address - Phone:415-298-1292
Mailing Address - Fax:510-521-9907
Practice Address - Street 1:450 PARK ST
Practice Address - Street 2:SUITE 101
Practice Address - City:ALAMEDA
Practice Address - State:CA
Practice Address - Zip Code:94501-6295
Practice Address - Country:US
Practice Address - Phone:415-298-1292
Practice Address - Fax:510-521-9907
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-14
Last Update Date:2008-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC42788106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty