Healthcare Provider Details

I. General information

NPI: 1932781622
Provider Name (Legal Business Name): AARON LANE MARKS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2021
Last Update Date: 03/20/2025
Certification Date: 03/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 BEAN CREEK RD UNIT 87
SCOTTS VALLEY CA
95066-4147
US

IV. Provider business mailing address

380 ENCINAL ST STE 200
SANTA CRUZ CA
95060-2178
US

V. Phone/Fax

Practice location:
  • Phone: 831-419-3243
  • Fax:
Mailing address:
  • Phone: 831-469-1700
  • Fax: 831-425-1905

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number18509
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: