Healthcare Provider Details

I. General information

NPI: 1386835189
Provider Name (Legal Business Name): JASON NEWELL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2007
Last Update Date: 08/06/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4501 TAFT AVE
RICHMOND CA
94804-3449
US

IV. Provider business mailing address

PO BOX 1622
EL CERRITO CA
94530-4622
US

V. Phone/Fax

Practice location:
  • Phone: 510-235-3172
  • Fax:
Mailing address:
  • Phone: 510-235-3172
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: