Healthcare Provider Details

I. General information

NPI: 1265067185
Provider Name (Legal Business Name): OF TWO MINDS PSYCHOTHERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/11/2020
Last Update Date: 01/22/2024
Certification Date: 01/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

137 E HAMILTON AVE STE 205
CAMPBELL CA
95008-0244
US

IV. Provider business mailing address

PO BOX 110334
CAMPBELL CA
95011-0334
US

V. Phone/Fax

Practice location:
  • Phone: 415-841-3338
  • Fax:
Mailing address:
  • Phone: 415-841-3338
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: KADE FLACH
Title or Position: PSYCHOTHERAPIST/PRESIDENT
Credential: MS, LMFT
Phone: 415-841-3338