Healthcare Provider Details

I. General information

NPI: 1003943218
Provider Name (Legal Business Name): BRIAN AUGUSTUS BINGHAM MHA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2275 ARLINGTON DR
SAN LEANDRO CA
94578-1132
US

IV. Provider business mailing address

420 CENTRAL AVE APT 301
ALAMEDA CA
94501-3656
US

V. Phone/Fax

Practice location:
  • Phone: 510-481-1222
  • Fax:
Mailing address:
  • Phone: 510-481-1222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: