Healthcare Provider Details

I. General information

NPI: 1407960982
Provider Name (Legal Business Name): BETH OHANNESON BETH OHANNESON, MFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: BETH OHANNESON M.F.T.

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 03/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 FRANKLIN ST SUITE 303
SAN FRANCISCO CA
94102-6017
US

IV. Provider business mailing address

45 FRANKLIN ST SUITE 303
SAN FRANCISCO CA
94102-6017
US

V. Phone/Fax

Practice location:
  • Phone: 415-564-0782
  • Fax:
Mailing address:
  • Phone: 415-564-0782
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC29187
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: