Healthcare Provider Details

I. General information

NPI: 1669377826
Provider Name (Legal Business Name): BAYT AL-QULUB PSYCHOLOGY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2026
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

823 PAULSON CIR
MENLO PARK CA
94025-3680
US

IV. Provider business mailing address

6008 W LOOKOUT MOUNTAIN LN
SPOKANE WA
99208-7638
US

V. Phone/Fax

Practice location:
  • Phone: 650-722-4900
  • Fax: 509-479-8275
Mailing address:
  • Phone: 650-722-4900
  • Fax: 509-479-8275

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License Number
License Number StateNULL
# 6
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. AZADEH HOURMANESH WEBER
Title or Position: DIRECTOR, PSYCHOLOGIST
Credential: PSYD
Phone: 650-722-4900