Healthcare Provider Details

I. General information

NPI: 1235594367
Provider Name (Legal Business Name): HENRY WILLIAM OSTENDORF
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2015
Last Update Date: 12/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 MARKET ST
SAN FRANCISCO CA
94103-1513
US

IV. Provider business mailing address

1111 MARKET ST
SAN FRANCISCO CA
94103-1513
US

V. Phone/Fax

Practice location:
  • Phone: 415-683-3883
  • Fax: 415-863-3883
Mailing address:
  • Phone: 415-683-3883
  • Fax: 415-863-3883

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number223
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number223
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: