Healthcare Provider Details

I. General information

NPI: 1558674267
Provider Name (Legal Business Name): BIANCA HOVDA M.A., LMFT 90952
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2010
Last Update Date: 01/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 MYRTLE ST
OAKLAND CA
94607-2525
US

IV. Provider business mailing address

111 MYRTLE ST
OAKLAND CA
94607-2525
US

V. Phone/Fax

Practice location:
  • Phone: 510-922-9757
  • Fax:
Mailing address:
  • Phone: 510-922-9757
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberB8040595
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: