Healthcare Provider Details

I. General information

NPI: 1700037470
Provider Name (Legal Business Name): MOMENTUM FOR MENTAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2008
Last Update Date: 09/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 THE ALAMEDA
SAN JOSE CA
95126-1136
US

IV. Provider business mailing address

222 SANTA CRUZ AVE
APTOS CA
95003-4411
US

V. Phone/Fax

Practice location:
  • Phone: 408-261-7777
  • Fax:
Mailing address:
  • Phone: 408-812-1741
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. LINDA CLEVENGER
Title or Position: CASE MANAGER/COUNSELOR
Credential: C.A.S.; N.A.C.R.P.S.
Phone: 408-812-1741