Healthcare Provider Details

I. General information

NPI: 1417213273
Provider Name (Legal Business Name): THE WELL CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/05/2012
Last Update Date: 01/31/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

383 RHODE ISLAND ST SUITE 201
SAN FRANCISCO CA
94103-5177
US

IV. Provider business mailing address

383 RHODE ISLAND ST SUITE 201
SAN FRANCISCO CA
94103-5177
US

V. Phone/Fax

Practice location:
  • Phone: 415-935-4249
  • Fax:
Mailing address:
  • Phone: 415-935-4249
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License Number19546
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA117659
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC14698
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC51090
License Number StateCA

VIII. Authorized Official

Name: MR. CAMERON YARBROUGH
Title or Position: CLINICAL DIRECTOR
Credential: MFT
Phone: 415-935-4249