Healthcare Provider Details

I. General information

NPI: 1467208249
Provider Name (Legal Business Name): BAY AREA MHS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2024
Last Update Date: 04/24/2024
Certification Date: 04/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3775 BEACON AVE STE 233
FREMONT CA
94538-1468
US

IV. Provider business mailing address

3775 BEACON AVE STE 233
FREMONT CA
94538-1468
US

V. Phone/Fax

Practice location:
  • Phone: 510-240-9322
  • Fax:
Mailing address:
  • Phone: 408-655-7957
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: TUJNG THANH TRAN
Title or Position: CEO
Credential: LMFT
Phone: 408-655-7957