Healthcare Provider Details

I. General information

NPI: 1417674706
Provider Name (Legal Business Name): MEN'S THERAPY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2022
Last Update Date: 10/26/2022
Certification Date: 10/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 CALIFORNIA AVE STE 107
PALO ALTO CA
94306-1637
US

IV. Provider business mailing address

230 CALIFORNIA AVE STE 107
PALO ALTO CA
94306-1637
US

V. Phone/Fax

Practice location:
  • Phone: 858-442-6834
  • Fax:
Mailing address:
  • Phone: 858-442-6834
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. ROSS SIDEN NELSON
Title or Position: CEO
Credential: PSY.D.
Phone: 415-874-5652