Healthcare Provider Details

I. General information

NPI: 1366801482
Provider Name (Legal Business Name): WALNUT CREEK DBT PSYCHOLOGY CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/17/2016
Last Update Date: 02/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 QUAIL CT SUITE 204
WALNUT CREEK CA
94596-5547
US

IV. Provider business mailing address

45 QUAIL CT SUITE 204
WALNUT CREEK CA
94596-5547
US

V. Phone/Fax

Practice location:
  • Phone: 925-956-4636
  • Fax:
Mailing address:
  • Phone: 925-956-4636
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number24279
License Number StateCA

VIII. Authorized Official

Name: PATRICIA ZURITA ONA
Title or Position: CEO
Credential:
Phone: 925-956-4636