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NPI Code Detail

MEDICARE: JASPER BEAR INTERN

MEDICARE: JASPER BEAR INTERN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106H00000XMarriage & Family Therapist150436CA
2101Y00000XCounselor

General Provider Information

NPI Number : 1245018852
Entity Type Code : Individual
Provider Name (Legal Business Name) : JASPER BEAR INTERN
Provider Business Mailing Address
First Line : 4900 SHATTUCK AVE
Second Line : P.O. BOX 3275
City : OAKLAND
State : CA
Zip : 94609-2031
Country : US
Telephone Number : 510-206-6870
Fax Number :
Provider Business Practice Location Address
First Line : 1820 SCENIC AVE
Second Line :
City : BERKELEY
State : CA
Zip : 94709-1395
Country : US
Telephone Number : 510-206-6870
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/15/2023
Last Update Date : 10/14/2024

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Directions to “ JASPER BEAR INTERN” Practice Location

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