Healthcare Provider Details

I. General information

NPI: 1558064030
Provider Name (Legal Business Name): WELLNESS OF MIND PSYCHOTHERAPY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2023
Last Update Date: 03/23/2023
Certification Date: 03/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3099 TELEGRAPH AVE
BERKELEY CA
94705-2035
US

IV. Provider business mailing address

3099 TELEGRAPH AVE
BERKELEY CA
94705-2035
US

V. Phone/Fax

Practice location:
  • Phone: 510-438-1960
  • Fax:
Mailing address:
  • Phone: 510-438-1960
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: CAMERON MURPHEY
Title or Position: CO-OWNER
Credential: LMFT
Phone: 425-652-2673