Healthcare Provider Details

I. General information

NPI: 1720413040
Provider Name (Legal Business Name): MEHERET FIKRE-SELLASSIE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2013
Last Update Date: 09/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 LEE ST APT 1001
OAKLAND CA
94610-4325
US

IV. Provider business mailing address

320 LEE ST APT 1001
OAKLAND CA
94610-4325
US

V. Phone/Fax

Practice location:
  • Phone: 510-219-6916
  • Fax:
Mailing address:
  • Phone: 510-219-6916
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: