Healthcare Provider Details

I. General information

NPI: 1356695209
Provider Name (Legal Business Name): FELTON INSTITUTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2012
Last Update Date: 02/14/2020
Certification Date: 02/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1145 N CALIFORNIA ST
STOCKTON CA
95202-1537
US

IV. Provider business mailing address

1500 FRANKLIN ST
SAN FRANCISCO CA
94109-4523
US

V. Phone/Fax

Practice location:
  • Phone: 415-474-7310
  • Fax:
Mailing address:
  • Phone: 415-474-7310
  • Fax: 415-931-0972

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: MARVIN DAVIS
Title or Position: CHIEF FINANCIAL & OPERATIONS OFFICE
Credential:
Phone: 415-474-7310