Healthcare Provider Details

I. General information

NPI: 1295888352
Provider Name (Legal Business Name): ROBERT HOWARD MFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/19/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 BROADWAY STE 201
MILLBRAE CA
94030-1966
US

IV. Provider business mailing address

510 BROADWAY STE 201
MILLBRAE CA
94030-1966
US

V. Phone/Fax

Practice location:
  • Phone: 650-697-6866
  • Fax: 415-550-6673
Mailing address:
  • Phone: 650-697-6866
  • Fax: 415-550-6673

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMFT012692
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: