Healthcare Provider Details

I. General information

NPI: 1679636062
Provider Name (Legal Business Name): DEBRA D KOUNTZ BSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2006
Last Update Date: 08/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

939 MARKET ST. FL 4
SAN FRANCISCO CA
94103-2603
US

IV. Provider business mailing address

939 MARKET ST FL 4
SAN FRANCISCO CA
94103-1730
US

V. Phone/Fax

Practice location:
  • Phone: 415-597-8000
  • Fax: 415-597-8004
Mailing address:
  • Phone: 415-597-8000
  • Fax: 415-597-8004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: