Healthcare Provider Details

I. General information

NPI: 1063849735
Provider Name (Legal Business Name): FREE AT LAST CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2013
Last Update Date: 09/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1796 BAY RD
EAST PALO ALTO CA
94303-1611
US

IV. Provider business mailing address

1796 BAY RD
EAST PALO ALTO CA
94303-1611
US

V. Phone/Fax

Practice location:
  • Phone: 650-462-6999
  • Fax: 650-462-1055
Mailing address:
  • Phone: 650-462-6999
  • Fax: 650-462-1055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number410027IN
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number410027IN
License Number StateCA

VIII. Authorized Official

Name: ELIZABETH CHEWNING
Title or Position: PROGRAM ADMINISTRATION
Credential:
Phone: 650-462-6995