Healthcare Provider Details

I. General information

NPI: 1922719343
Provider Name (Legal Business Name): SANTA CRUZ PSYCHOTHERAPY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2022
Last Update Date: 02/09/2023
Certification Date: 02/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

830 BAY AVE
CAPITOLA CA
95010-2167
US

IV. Provider business mailing address

PO BOX 4269
SANTA CRUZ CA
95063-4269
US

V. Phone/Fax

Practice location:
  • Phone: 831-302-2323
  • Fax:
Mailing address:
  • Phone: 831-302-2323
  • 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 Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: LINDSAY KALJIAN
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 831-302-2324