Healthcare Provider Details

I. General information

NPI: 1578397352
Provider Name (Legal Business Name): THE BAY PSYCHOTHERAPY CENTER PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2024
Last Update Date: 08/26/2024
Certification Date: 08/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10781 CALLE MAR DE MARIPOSA
SAN DIEGO CA
92130-8656
US

IV. Provider business mailing address

548 MARKET ST # 275191
SAN FRANCISCO CA
94104-5401
US

V. Phone/Fax

Practice location:
  • Phone: 628-400-7434
  • Fax:
Mailing address:
  • Phone: 628-400-7434
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. AXEL VALLE ALERHAND
Title or Position: DIRECTOR
Credential: PSYD
Phone: 628-400-7434