Healthcare Provider Details

I. General information

NPI: 1386126621
Provider Name (Legal Business Name): ALUM ROCK COUNSELING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2018
Last Update Date: 09/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14281 STORY ROAD
SAN JOSE CA
95127
US

IV. Provider business mailing address

1245 E SANTA CLARA ST
SAN JOSE CA
95116-2337
US

V. Phone/Fax

Practice location:
  • Phone: 408-240-0070
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MAXIMILIAN MASAHITO KUBOTA
Title or Position: QA MANAGER
Credential: LMFT
Phone: 408-394-1761