Healthcare Provider Details

I. General information

NPI: 1740166974
Provider Name (Legal Business Name): CHILDREN'S HEALTH COUNCIL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2025
Last Update Date: 08/13/2025
Certification Date: 08/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2095 WARMWOOD LN
SAN JOSE CA
95132-1251
US

IV. Provider business mailing address

650 CLARK WAY
PALO ALTO CA
94304-2300
US

V. Phone/Fax

Practice location:
  • Phone: 650-326-5530
  • Fax:
Mailing address:
  • Phone: 650-326-5530
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: JUSTIN JOSEPH LEMOS
Title or Position: DIRECTOR OF INFORMATION SYSTEMS
Credential:
Phone: 650-702-2488