Healthcare Provider Details

I. General information

NPI: 1669986477
Provider Name (Legal Business Name): COMMUNITY OPTIONS FOR FAMILIES AND YOUTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2017
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1750 HARBOR ST
PITTSBURG CA
94565-4615
US

IV. Provider business mailing address

3478 BUSKIRK AVE STE 260
PLEASANT HILL CA
94523-4358
US

V. Phone/Fax

Practice location:
  • Phone: 925-473-2390
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: DAVID BERGESEN
Title or Position: EXECUTIVE DIRECTOR
Credential: LMFT
Phone: 925-943-1794