Healthcare Provider Details

I. General information

NPI: 1639512759
Provider Name (Legal Business Name): WESLEY NOBUO KOBASHIGAWA LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2013
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1190 LINCOLN AVE STE 6
SAN JOSE CA
95125-3036
US

IV. Provider business mailing address

809 CUESTA DR STE B
MOUNTAIN VIEW CA
94040-3669
US

V. Phone/Fax

Practice location:
  • Phone: 650-318-1092
  • Fax:
Mailing address:
  • Phone: 650-318-1092
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number36872
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number96152
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number4581-R
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: