Healthcare Provider Details

I. General information

NPI: 1023642006
Provider Name (Legal Business Name): WESTCOAST THERAPY AND WELLNESS PROFESSIONAL CLINICAL COUNSELOR PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2020
Last Update Date: 02/27/2020
Certification Date: 02/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 SUTTER ST RM 1336
SAN FRANCISCO CA
94108-4007
US

IV. Provider business mailing address

20 HAPPY VALLEY RD
PLEASANTON CA
94566-9792
US

V. Phone/Fax

Practice location:
  • Phone: 415-844-9343
  • Fax:
Mailing address:
  • Phone: 415-844-9343
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: CHRISTY TADROS
Title or Position: PRESIDENT
Credential: LPCC
Phone: 415-844-9343