Healthcare Provider Details

I. General information

NPI: 1578318291
Provider Name (Legal Business Name): JULIET NATALIE AI SMALL ERNST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2024
Last Update Date: 04/18/2024
Certification Date: 04/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5299 COLLEGE AVE STE P
OAKLAND CA
94618-2816
US

IV. Provider business mailing address

PO BOX 8401
EMERYVILLE CA
94662-0401
US

V. Phone/Fax

Practice location:
  • Phone: 510-216-3988
  • Fax:
Mailing address:
  • Phone: 510-216-3988
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number10166
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number127880
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: