Provider Demographics
NPI:1932563871
Name:MOSTREL, ETHEL (MARRIAGE FAMILY THER)
Entity type:Individual
Prefix:MS
First Name:ETHEL
Middle Name:
Last Name:MOSTREL
Suffix:
Gender:F
Credentials:MARRIAGE FAMILY THER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 CAMBRIDGE AVE
Mailing Address - Street 2:SUITE 7
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94306-1600
Mailing Address - Country:US
Mailing Address - Phone:650-799-1375
Mailing Address - Fax:
Practice Address - Street 1:415 CAMBRIDGE AVE
Practice Address - Street 2:SUITE 7
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94306-1600
Practice Address - Country:US
Practice Address - Phone:650-799-1375
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-06
Last Update Date:2016-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA27981101Y00000X, 101YM0800X
27981101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional