Healthcare Provider Details

I. General information

NPI: 1790827590
Provider Name (Legal Business Name): ROYANNE UKESTAD LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/12/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17705 HALE AVE STE F2
MORGAN HILL CA
95037-4349
US

IV. Provider business mailing address

1005 HIGHLAND AVE
SAN MARTIN CA
95046-9433
US

V. Phone/Fax

Practice location:
  • Phone: 408-779-8874
  • Fax:
Mailing address:
  • Phone: 408-683-4062
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC15695
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: