Healthcare Provider Details

I. General information

NPI: 1811790363
Provider Name (Legal Business Name): MIND HARBOR PSYCHOLOGICAL SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2025
Last Update Date: 09/04/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2570 N 1ST ST STE 200
SAN JOSE CA
95131-1037
US

IV. Provider business mailing address

2570 N 1ST ST STE 200
SAN JOSE CA
95131-1037
US

V. Phone/Fax

Practice location:
  • Phone: 650-613-9897
  • Fax: 650-391-0569
Mailing address:
  • Phone: 650-613-9897
  • Fax: 650-391-0569

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. JET HERMES
Title or Position: OWNER
Credential: PSY.D.
Phone: 650-613-9897