Healthcare Provider Details

I. General information

NPI: 1144831413
Provider Name (Legal Business Name): FAVIN MEHARI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2020
Last Update Date: 10/19/2023
Certification Date: 10/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1555 PARKMOOR AVE
SAN JOSE CA
95128-2407
US

IV. Provider business mailing address

PO BOX 238
NAPA CA
94559-0238
US

V. Phone/Fax

Practice location:
  • Phone: 408-282-0402
  • Fax:
Mailing address:
  • Phone: 707-255-3300
  • Fax: 707-255-3527

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: