Healthcare Provider Details

I. General information

NPI: 1043891146
Provider Name (Legal Business Name): DUSTYN MICHAEL SALOMON AMFT, APCC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2021
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

445 S SAN ANTONIO RD STE 204
LOS ALTOS CA
94022-3638
US

IV. Provider business mailing address

1344 ANZA ST APT D
SAN FRANCISCO CA
94118-3984
US

V. Phone/Fax

Practice location:
  • Phone: 650-618-6434
  • Fax:
Mailing address:
  • Phone: 707-407-5155
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number140707
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number14341
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: