Healthcare Provider Details

I. General information

NPI: 1417874553
Provider Name (Legal Business Name): PILAR PRIME
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2026
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1327 SIR FRANCIS DRAKE BLVD
SAN ANSELMO CA
94960-1800
US

IV. Provider business mailing address

PO BOX 43
SAN ANSELMO CA
94979-0043
US

V. Phone/Fax

Practice location:
  • Phone: 603-502-3235
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number155059
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: